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Can the Risk of Lymph Node Metastases Be Gauged in Endoscopically Resected Submucosal Esophageal Adenocarcinomas? A Multi-Center Study.
J Gastrointest Surg 2016; 20(1):6-12; discussion 12JG

Abstract

Endoscopic resection (ER) allows for local therapy of superficial esophageal cancers. Factors reported to be associated with an increased risk of lymph node metastases in patients with adenocarcinoma are poor differentiation, lymphovascular invasion (LVI), and submucosal invasion >500 μ. The aim of this study was to determine whether depth of invasion and tumor characteristics in an ER specimen can be used to gauge the risk of lymph node metastases in patients with superficial esophageal adenocarcinoma. Patients from seven US centers that had ER of an adenocarcinoma followed by an esophagectomy were identified. The ER pathology slides were rereviewed by three experienced GI pathologists for depth of invasion, presence of LVI, and tumor differentiation. The findings from the ER specimen were correlated with the presence and number of lymph node metastases in the final esophagectomy specimen. There were 19 T1a and 23 T1b tumors. A median of 24 nodes were resected per patient. None of the T1a tumors had involved lymph nodes despite the presence of LVI in 5% and poor differentiation in 21% of patients. In contrast, 26% of T1b tumors had involved nodes. None of the four patients with submucosal invasion ≤500 μ, no LVI, and no poor differentiation had involved nodes. However, with an increasing number of risk factors, the likelihood of involved lymph nodes increased, reaching 50% when all three factors were present. Endoscopic therapy appears appropriate for intramucosal tumors and may be an option for low-risk T1b tumors. Esophagectomy is preferred for patients with submucosal invasion and one or more risk factors.

Authors+Show Affiliations

Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St, Suite 514, Los Angeles, CA, 90033, USA.Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St, Suite 514, Los Angeles, CA, 90033, USA.Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.Department of Pathology, Mayo Clinic, Rochester, MN, USA.Department of Surgery, Mayo Clinic, Rochester, MN, USA.Department of Surgery, Mayo Clinic, Rochester, MN, USA.Department of Surgery, Oregon Clinic, Portland, OR, USA.Department of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.Department of Surgery, University of Rochester, New York, NY, USA.Department of Surgery, Swedish Cancer Institute, Seattle, WA, USA.Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.Department of Surgery, University of Rochester, New York, NY, USA.Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St, Suite 514, Los Angeles, CA, 90033, USA. steven.demeester@med.usc.edu.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

26408330

Citation

Boys, Joshua A., et al. "Can the Risk of Lymph Node Metastases Be Gauged in Endoscopically Resected Submucosal Esophageal Adenocarcinomas? a Multi-Center Study." Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, vol. 20, no. 1, 2016, pp. 6-12; discussion 12.
Boys JA, Worrell SG, Chandrasoma P, et al. Can the Risk of Lymph Node Metastases Be Gauged in Endoscopically Resected Submucosal Esophageal Adenocarcinomas? A Multi-Center Study. J Gastrointest Surg. 2016;20(1):6-12; discussion 12.
Boys, J. A., Worrell, S. G., Chandrasoma, P., Vallone, J. G., Maru, D. M., Zhang, L., ... DeMeester, S. R. (2016). Can the Risk of Lymph Node Metastases Be Gauged in Endoscopically Resected Submucosal Esophageal Adenocarcinomas? A Multi-Center Study. Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, 20(1), pp. 6-12; discussion 12. doi:10.1007/s11605-015-2950-9.
Boys JA, et al. Can the Risk of Lymph Node Metastases Be Gauged in Endoscopically Resected Submucosal Esophageal Adenocarcinomas? a Multi-Center Study. J Gastrointest Surg. 2016;20(1):6-12; discussion 12. PubMed PMID: 26408330.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can the Risk of Lymph Node Metastases Be Gauged in Endoscopically Resected Submucosal Esophageal Adenocarcinomas? A Multi-Center Study. AU - Boys,Joshua A, AU - Worrell,Stephanie G, AU - Chandrasoma,Parakrama, AU - Vallone,John G, AU - Maru,Dipen M, AU - Zhang,Lizhi, AU - Blackmon,Shanda H, AU - Dickinson,Karen J, AU - Dunst,Christy M, AU - Hofstetter,Wayne L, AU - Lada,Michael J, AU - Louie,Brian E, AU - Molena,Daniela, AU - Watson,Thomas J, AU - DeMeester,Steven R, Y1 - 2015/09/25/ PY - 2015/05/19/received PY - 2015/09/14/accepted PY - 2015/9/27/entrez PY - 2015/9/27/pubmed PY - 2016/8/11/medline KW - Barrett’s esophagus KW - Endoscopic resection KW - Esophageal adenocarcinoma KW - Esophagectomy SP - 6-12; discussion 12 JF - Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract JO - J. Gastrointest. Surg. VL - 20 IS - 1 N2 - Endoscopic resection (ER) allows for local therapy of superficial esophageal cancers. Factors reported to be associated with an increased risk of lymph node metastases in patients with adenocarcinoma are poor differentiation, lymphovascular invasion (LVI), and submucosal invasion >500 μ. The aim of this study was to determine whether depth of invasion and tumor characteristics in an ER specimen can be used to gauge the risk of lymph node metastases in patients with superficial esophageal adenocarcinoma. Patients from seven US centers that had ER of an adenocarcinoma followed by an esophagectomy were identified. The ER pathology slides were rereviewed by three experienced GI pathologists for depth of invasion, presence of LVI, and tumor differentiation. The findings from the ER specimen were correlated with the presence and number of lymph node metastases in the final esophagectomy specimen. There were 19 T1a and 23 T1b tumors. A median of 24 nodes were resected per patient. None of the T1a tumors had involved lymph nodes despite the presence of LVI in 5% and poor differentiation in 21% of patients. In contrast, 26% of T1b tumors had involved nodes. None of the four patients with submucosal invasion ≤500 μ, no LVI, and no poor differentiation had involved nodes. However, with an increasing number of risk factors, the likelihood of involved lymph nodes increased, reaching 50% when all three factors were present. Endoscopic therapy appears appropriate for intramucosal tumors and may be an option for low-risk T1b tumors. Esophagectomy is preferred for patients with submucosal invasion and one or more risk factors. SN - 1873-4626 UR - https://www.unboundmedicine.com/medline/citation/26408330/Can_the_Risk_of_Lymph_Node_Metastases_Be_Gauged_in_Endoscopically_Resected_Submucosal_Esophageal_Adenocarcinomas_A_Multi_Center_Study_ L2 - https://dx.doi.org/10.1007/s11605-015-2950-9 DB - PRIME DP - Unbound Medicine ER -