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Are endoscopic therapies appropriate for superficial submucosal esophageal adenocarcinoma? An analysis of esophagectomy specimens.
J Am Coll Surg 2010; 210(4):418-27JA

Abstract

BACKGROUND

Endoscopic resection and ablation have advanced the treatment of intramucosal esophageal adenocarcinoma and have been promoted as definitive therapy for selected superficial submucosal tumors. Controversy exists regarding the prevalence of nodal metastases at various depths of mucosal and submucosal invasion. Our aim was to clarify this prevalence and identify predictors of nodal spread.

STUDY DESIGN

An expert gastrointestinal pathologist retrospectively reviewed 54 T1 adenocarcinomas from 258 esophagectomy specimens (2000 to 2008). Tumors were classified as intramucosal or submucosal, the latter being subclassified as SM1 (upper third), SM2 (middle third), or SM3 (lower third) based on the depth of tumor invasion. The depth of invasion was correlated with the prevalence of positive nodes. Fisher's exact test and univariate and multivariate logistic regression were used to identify variables predicting nodal disease.

RESULTS

Nodal metastases were present in 0% (0 of 25) of intramucosal, 21% (3 of 14) of SM1, 36% (4 of 11) of SM2, and 50% (2 of 4) of SM3 tumors. The differences were significant between intramucosal and submucosal tumors (p < 0.0001), although not between the various subclassifications of submucosal tumors (p = 0.503). Univariate logistic regression identified poor differentiation (p = 0.024), lymphovascular invasion (p = 0.049), and number of harvested lymph nodes (p = 0.037) as significantly correlated with nodal disease. Multivariate logistic regression did not identify any of the tested variables as independent predictors of the prevalence of positive lymph nodes.

CONCLUSIONS

All depths of submucosal invasion of esophageal adenocarcinoma were associated with an unacceptably high prevalence of nodal metastases and a marked increase relative to intramucosal cancer. Accurate predictors of nodal spread, independent of tumor depth, are currently lacking and will be necessary before recommending endoscopic resection with or without concomitant ablation as curative treatment for even superficial submucosal neoplasia.

Authors+Show Affiliations

Division of Thoracic and Foregut Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20347733

Citation

Sepesi, Boris, et al. "Are Endoscopic Therapies Appropriate for Superficial Submucosal Esophageal Adenocarcinoma? an Analysis of Esophagectomy Specimens." Journal of the American College of Surgeons, vol. 210, no. 4, 2010, pp. 418-27.
Sepesi B, Watson TJ, Zhou D, et al. Are endoscopic therapies appropriate for superficial submucosal esophageal adenocarcinoma? An analysis of esophagectomy specimens. J Am Coll Surg. 2010;210(4):418-27.
Sepesi, B., Watson, T. J., Zhou, D., Polomsky, M., Litle, V. R., Jones, C. E., ... Peters, J. H. (2010). Are endoscopic therapies appropriate for superficial submucosal esophageal adenocarcinoma? An analysis of esophagectomy specimens. Journal of the American College of Surgeons, 210(4), pp. 418-27. doi:10.1016/j.jamcollsurg.2010.01.003.
Sepesi B, et al. Are Endoscopic Therapies Appropriate for Superficial Submucosal Esophageal Adenocarcinoma? an Analysis of Esophagectomy Specimens. J Am Coll Surg. 2010;210(4):418-27. PubMed PMID: 20347733.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are endoscopic therapies appropriate for superficial submucosal esophageal adenocarcinoma? An analysis of esophagectomy specimens. AU - Sepesi,Boris, AU - Watson,Thomas J, AU - Zhou,David, AU - Polomsky,Marek, AU - Litle,Virginia R, AU - Jones,Carolyn E, AU - Raymond,Daniel P, AU - Hu,Rui, AU - Qiu,Xing, AU - Peters,Jeffrey H, PY - 2009/11/08/received PY - 2010/01/04/revised PY - 2010/01/04/accepted PY - 2010/3/30/entrez PY - 2010/3/30/pubmed PY - 2010/4/7/medline SP - 418 EP - 27 JF - Journal of the American College of Surgeons JO - J. Am. Coll. Surg. VL - 210 IS - 4 N2 - BACKGROUND: Endoscopic resection and ablation have advanced the treatment of intramucosal esophageal adenocarcinoma and have been promoted as definitive therapy for selected superficial submucosal tumors. Controversy exists regarding the prevalence of nodal metastases at various depths of mucosal and submucosal invasion. Our aim was to clarify this prevalence and identify predictors of nodal spread. STUDY DESIGN: An expert gastrointestinal pathologist retrospectively reviewed 54 T1 adenocarcinomas from 258 esophagectomy specimens (2000 to 2008). Tumors were classified as intramucosal or submucosal, the latter being subclassified as SM1 (upper third), SM2 (middle third), or SM3 (lower third) based on the depth of tumor invasion. The depth of invasion was correlated with the prevalence of positive nodes. Fisher's exact test and univariate and multivariate logistic regression were used to identify variables predicting nodal disease. RESULTS: Nodal metastases were present in 0% (0 of 25) of intramucosal, 21% (3 of 14) of SM1, 36% (4 of 11) of SM2, and 50% (2 of 4) of SM3 tumors. The differences were significant between intramucosal and submucosal tumors (p < 0.0001), although not between the various subclassifications of submucosal tumors (p = 0.503). Univariate logistic regression identified poor differentiation (p = 0.024), lymphovascular invasion (p = 0.049), and number of harvested lymph nodes (p = 0.037) as significantly correlated with nodal disease. Multivariate logistic regression did not identify any of the tested variables as independent predictors of the prevalence of positive lymph nodes. CONCLUSIONS: All depths of submucosal invasion of esophageal adenocarcinoma were associated with an unacceptably high prevalence of nodal metastases and a marked increase relative to intramucosal cancer. Accurate predictors of nodal spread, independent of tumor depth, are currently lacking and will be necessary before recommending endoscopic resection with or without concomitant ablation as curative treatment for even superficial submucosal neoplasia. SN - 1879-1190 UR - https://www.unboundmedicine.com/medline/citation/20347733/Are_endoscopic_therapies_appropriate_for_superficial_submucosal_esophageal_adenocarcinoma_An_analysis_of_esophagectomy_specimens_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1072-7515(10)00006-2 DB - PRIME DP - Unbound Medicine ER -