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Lymphovascular Invasion as the Major Prognostic Factor in Node-Negative Esophageal Cancer After Primary Esophagectomy

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Studies addressing both lymphovascular invasion (LVI) and perineural invasion (PNI) in patients with esophageal squamous cell carcinoma (ESCC) treated with or without neoadjuvant therapy are limited. We aimed to analyze the incidence and prognostic significance of LVI and PNI in patients with thoracic ESCC.

Methods

This retrospective study included 520 patients with ESCC: 174 patients after neoadjuvant treatment followed by surgery and 346 after primary esophagectomy, from two medical centers. The relationships between LVI, PNI, and other histological factors were evaluated. The Cox regression model was used for survival analysis.

Results

Positive LVI and PNI were noted in 35.6% and 22.4% of patients with residual primary tumor after neoadjuvant treatment and in 39.6% and 24.0% of patients who underwent primary esophagectomy, respectively. In patients with neoadjuvant treatments, the 5-year overall survival rates were 12.7% and 28.3% in patients with positive LVI and negative LVI, respectively (p = 0.001). The 5-year overall survival rates were 6.4% and 29.9% in patients with positive PNI and negative PNI, respectively (p < 0.001). In patients who did not receive neoadjuvant treatment, the 5-year overall survival rates were 28.2% and 61.1% in patients with positive LVI and negative LVI, respectively (p < 0.001). The 5-year overall survival rates were 30.2% and 52.5% in patients with positive PNI and negative PNI (p < 0.001). In subgroup analysis, the presence of PNI was an independent prognostic factor in patients with neoadjuvant treatments, whereas the presence of LVI had more significant prognostic impact in patients with node-negative ESCC after primary esophagectomy.

Conclusions

Both LVI and PNI statuses are significant prognostic factors for patients with ESCC. However, the prognostic impact of LVI was majorly in the subgroup of node-negative patients who received primary esophagectomy.

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Acknowledgments

We would like to especially thank all the members in the Taipei Veterans General Hospital Esophageal Cancer Panel and Taichung Veterans General Hospital Esophageal Cancer Panel for assisting with patient care and data collection.

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Author notes

  1. Chung-Ping Hsu, Cheng-Yen Chuang and Po-Kuei Hsu contributed equally to this work.

Authors and Affiliations

  1. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Chung-Ping Hsu, Po-Kuei Hsu, Yi-Chen Yeh, Han-Shui Hsu & Yu-Chung Wu

  2. Division of Thoracic Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Sec 3, Chung-Yang Rd., 970, Hualien, Taiwan

    Chung-Ping Hsu

  3. Division of Thoracic Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan

    Cheng-Yen Chuang & Chih-Hung Lin

  4. Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

    Po-Kuei Hsu, Han-Shui Hsu & Yu-Chung Wu

  5. Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan

    Ling-I Chien

  6. Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan

    Yi-Chen Yeh

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  1. Chung-Ping Hsu
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Contributions

Hsu CP: conception and design of the work, interpretation of data, and final approval.

Chung CY: substantial contributions to data acquisition and final approval.

Hsu PK: design of the work data analysis and drafting the work.

Chien LI: substantial contributions to data acquisition (Taipei VGH).

Lin CH: substantial contributions to data acquisition (Taichung VGH).

Yeh YC: substantial contributions to data interpretation and analysis.

Hsu HS: conception of the work and final approval.

Wu YC: conception of the work and final approval.

Corresponding author

Correspondence to Chung-Ping Hsu.

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Hsu, CP., Chuang, CY., Hsu, PK. et al. Lymphovascular Invasion as the Major Prognostic Factor in Node-Negative Esophageal Cancer After Primary Esophagectomy. J Gastrointest Surg 24, 1459–1468 (2020). https://doi.org/10.1007/s11605-019-04310-0

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  • DOI: https://doi.org/10.1007/s11605-019-04310-0

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