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Risk Stratification for Early Esophageal Adenocarcinoma: Analysis of Lymphatic Spread and Prognostic Factors

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Knowledge of factors related to outcome is vital for the selection of therapeutic alternatives for patients with early (T1) esophageal adenocarcinoma. This study was undertaken to determine predictors of lymphatic spread and prognostic factors for T1 esophageal adenocarcinoma following esophagectomy.

Materials and Methods

A prospectively maintained database identified 85 patients with T1 esophageal adenocarcinoma who underwent esophagectomy without neoadjuvant therapy. Depth of tumor invasion (T stage) was subdivided into mucosal (T1a) or submucosal invasion (T1b). Median follow-up was 59 months.

Results

Thoracoscopically assisted 3-phase esophagectomy was performed in 73 of 85 patients (86%). Lymph node metastases (N stage) were identified in 9 of 85 patients (11%). Depth of tumor invasion (T stage), lymphovascular invasion (LVI), and poor differentiation were associated with N stage. The patients could be stratified into 4 risk groups for lymph node metastases: group I—T1a (0 of 35 patients [0%] with positive nodes); group II—T1b, well/moderate differentiation and no LVI (1 of 28 patients [4%] with positive nodes); group III—T1b, poor differentiation and no LVI (2 of 9 patients [22%] with positive nodes); and group IV—T1b any grade with LVI (6 of 13 patients [46%] with positive nodes). Survival analyses found T stage, N stage, LVI, and poor differentiation to be significant prognostic factors.

Conclusions

Risk stratification is possible for patents with T1 esophageal adenocarcinoma. Local resection techniques without lymphadenectomy may be alternatives for T1a tumors. Esophagectomy should remain the standard of care for patients with T1b tumors and those with LVI or poor differentiation considered for neoadjuvant therapy.

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Authors and Affiliations

  1. Division of Surgery, University of Queensland, Brisbane, QLD, Australia

    Andrew P. Barbour PhD, David C. Gotley MD & B. Mark Smithers MD

  2. Department of Biostatistics, Princess Alexandra Hospital, Brisbane, QLD, Australia

    Mark Jones PhD

  3. Department of Pathology, Royal Brisbane Hospital, Brisbane, QLD, Australia

    Ian Brown MD

  4. Department of Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia

    Ian Martin MD & Janine Thomas MD

  5. Department of Pathology, Princess Alexandra Hospital, Brisbane, QLD, Australia

    Andrew Clouston PhD

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  1. Andrew P. Barbour PhD
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Correspondence to Andrew P. Barbour PhD.

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Barbour, A.P., Jones, M., Brown, I. et al. Risk Stratification for Early Esophageal Adenocarcinoma: Analysis of Lymphatic Spread and Prognostic Factors. Ann Surg Oncol 17, 2494–2502 (2010). https://doi.org/10.1245/s10434-010-1025-0

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  • DOI: https://doi.org/10.1245/s10434-010-1025-0

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