Pathologic prognostic factors in Barrett's associated adenocarcinoma: a follow-up study of 96 patients.

BACKGROUND: The objective of this study was to evaluate a variety of histologic features, some of which to our knowledge have never been evaluated in Barrett's-associated adenocarcinoma (BAd) (such as Crohn's-like lymphoid reaction and peritumoral lymphoid response) in patients with and without preoperative neoadjuvant chemotherapy combined with radiotherapy (chemrad) to determine their prognostic significance in these two groups of patients.
METHODS: Tumor sections from 96 patients (83 males and 13 females; mean age, 62 years) with resected BAd (61 with chemrad and 35 without chemrad) were evaluated for numerous histologic features such as pathologic stage according to the American Joint Committee on Cancer TNM staging system, peritumoral lymphoid infiltrate, Crohn's-like lymphoid reaction, and degree of post chemrad residual tumor and correlated with the preoperative chemrad status and with survival (mean follow-up, 23 months).
RESULTS: By univariate analysis, older patient age (P = 0.02), higher pathologic stage (P = 0.02) (including depth of invasion and lymph node status), infiltrative growth pattern (P = 0.05), perineural invasion (P = 0.05), vascular invasion (P = 0.04), and the absence of a peritumoral lymphoid infiltrate (P = 0.04) were associated with shortened survival in the entire cohort and in patients without chemrad, with the exception of infiltrative growth pattern (P = 0.1 in the nonchemrad group only). Higher stage was the only feature associated with decreased survival in the chemrad group. Subcategorization of lymph nodes according to the number involved with metastases (fewer than four, four to seven, and greater than seven) had no further effect on prognosis. However, subcategorization of T1 tumors into Tla and T1b did influence prognosis in a negative manner. Using multivariate analysis, only older patient age (P = 0.005) and the absence of a peritumoral lymphoid infiltrate (P = 0.05) were statistically associated with poor survival independent of stage. In addition, perineural invasion (P = 0.07) showed a trend toward shortened survival in patients with this feature. Preoperative chemrad had no effect on survival in this retrospective nonrandomized cohort of patients.
CONCLUSIONS: This study confirms the strong prognostic usefulness of the TNM staging system in patients with resected BAd, even in those patients who received preoperative chemrad. In addition, older patient age, the absence of a peritumoral lymphoid infiltrate, and possibly perineural invasion correlate with poor survival independent of pathologic stage in patients with these tumors.