Lymphangiosis carcinomatosa: unabhängiger Prognosefaktor bei Patienten mit Plattenepithelcarcinom des Oesophagus

Abstract

Background: The objective of this study was to clarify the presence and prognostic impact of LVI in a large number of patients resected for esophageal squamous cell carcinoma (SCC) at one surgical center. Methods: Therefore, 366 patients, which had a primary resection for SCC, were analysed by uni- and multivariate analysis. Follow-up is complete for 93.7% patients with a median follow-up of 8.3 years. Results: The total rate of LVI was 39.1% (n = 143). Univariate analysis revealed a significant relationship between LVI and different T-categories (p = 0.001), N-categories (p < 0.0001), M-categories (p < 0.0001), UICC-stages (p < 0.0001) and residual tumor (p < 0.0001). Multivariate analysis of the R0-resected patients proved LVI as an independent prognostic factor. The 2-, 5- and 10-year-survival-rates in patients with LVI were 28.5%, 11.1% and 9.2% compared to 63.4%, 46.6% and 27% without LVI (p < 0.0001). Patients with LVI had a median-survival-time of 11.4 months compared to 28.6 months without LVI (p < 0.0001). R0-resected patients without LVI had a median-survival-time of 54.1 months compared to 12.1 months in patients with LVI (p < 0.0001) and compared to 11.3 months in R1-resected patients (p < 0.0001). Conclusions: These data clearly show, that LVI is an independent prognostic factor in patients with SCC and confirm the importance of a systematic histopathological workup. The prognosis of R0-resected patients with LVI is equal to patients with an incomplete tumor resection. This supports the inclusion of LVI in the UlCC-classification system for esophageal carcinoma.