Identifying Low-Risk and High-Risk T1 Esophageal Adenocarcinoma Based on Pathologic Risk Factors.
Jon Davison, James Luketitch, Michael Gibson, Rodney Landreneau, Katie Nason. UPMC, Pittsburgh, PA
Background: Pathologic evaluation of endoscopic resection (EMR) specimens is a critical aspect of the pre-operative staging evaluation for superficially invasive adenocarcinoma of the esophagus and GE junction (stage T1-EAC), helping to direct appropriate treatment. The purpose of this study is to quantify the risk of lymph node metastasis (LNM) associated with known pathologic risk factors in a series of surgically resected T1-EAC.
Design: We reviewed pathology reports and clinical records from a consecutive series of 232 patients who underwent esophagectomy without induction therapy for T1-EAC at the UPMC between 1996 and 2009.
Results: Tumor size (Tsize), angiolymphatic invasion (ALI), submucosal invasion (stage T1b) and histologic grade (poorly differentiated, G3) were all significant risk factors for LNM on univariate analysis. When controlling for all four covariates, Tsize, ALI and grade were independent predictors of lymph node metastasis, but T stage was not (Table 1).
|Pathologic Risk Factors||LN Metastasis *|
|N/Total (%)||Adjusted OR (95% CI)|
|T stage||T1b||39/151 (25.8)||1.5 (0.44, 5.1)|
|Tumor size, cm (median, IQR)||(2.0, 1.0-3.0)||1.4 (1.1, 1.8)|
|ALI||+||28/44 (63.6)||10.5 (4.3, 26)|
|Grade||G3||23/65 (35.4)||3.0 (1.2, 7.2)|
|G1 or G2||22/163 (13.5)|
|Number of Risk Factors||LN Metastasis *|
|(T1b, ALI, G3, Tsize>1cm)||N/Total (%)|