Anthony M Gamboa1, Sungjin Kim2, Seth D Force3, Charles A Staley4, Kevin E Woods5, David A Kooby4, Shishir K Maithel4, Jennifer A Luke6, Katherine M Shaffer6, Sunil Dacha1, Nabil F Saba7, Steven A Keilin1, Qiang Cai1, Bassel F El-Rayes7, Zhengjia Chen2,7, Field F Willingham1. 1. Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. 2. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia. 3. Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia. 4. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia. 5. Interventional Endoscopy, Gastroenterology and Nutrition, Cancer Treatment Centers of America, Newnan, Georgia. 6. Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. 7. Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Abstract
BACKGROUND: In considering treatment allocation for patients with early esophageal adenocarcinoma, the incidence of lymph node metastasis is a critical determinant; however, this has not been well defined or stratified by the relevant clinical predictors of lymph node spread. METHODS: Data from the Surveillance, Epidemiology, and End Results database of the National Cancer Institute were abstracted from 2004 to 2010 for patients with early-stage esophageal adenocarcinoma. The incidence of lymph node involvement for patients with Tis, T1a, and T1b tumors was examined and was stratified by predictors of spread. RESULTS: A total of 13,996 patients with esophageal adenocarcinoma were evaluated. Excluding those with advanced, metastatic, and/or invasive (T2-T4) disease, 715 patients with Tis, T1a, and T1b tumors were included. On multivariate analysis, tumor grade (odds ratio [OR], 2.76; 95% confidence interval [95% CI], 1.58-4.82 [P<.001]), T classification (OR, 0.47; 95% CI, 0.24-0.91 [P =.025]), and tumor size (OR, 2.68; 95% CI, 1.48-4.85 [P = .001]) were found to be independently associated with lymph node metastases. There was no lymph node spread noted with Tis tumors. For patients with low-grade (well or moderately differentiated) tumors measuring <2 cm in size, the risk of lymph node metastasis was 1.7% for T1a (P<.001) and 8.6% for T1b (P = .001) tumors. CONCLUSIONS: For patients with low-grade Tis or T1 tumors measuring ≤2 cm in size, the incidence of lymph node metastasis appears to be comparable to the mortality rate associated with esophagectomy. For highly selected patients with early esophageal adenocarcinomas, the results of the current study support the recommendation that local endoscopic resection can be considered as an alternative to surgical management when followed by rigorous endoscopic and radiographic surveillance. Cancer 2016;122:2150-7.
BACKGROUND: In considering treatment allocation for patients with early esophageal adenocarcinoma, the incidence of lymph node metastasis is a critical determinant; however, this has not been well defined or stratified by the relevant clinical predictors of lymph node spread. METHODS: Data from the Surveillance, Epidemiology, and End Results database of the National Cancer Institute were abstracted from 2004 to 2010 for patients with early-stage esophageal adenocarcinoma. The incidence of lymph node involvement for patients with Tis, T1a, and T1b tumors was examined and was stratified by predictors of spread. RESULTS: A total of 13,996 patients with esophageal adenocarcinoma were evaluated. Excluding those with advanced, metastatic, and/or invasive (T2-T4) disease, 715 patients with Tis, T1a, and T1b tumors were included. On multivariate analysis, tumor grade (odds ratio [OR], 2.76; 95% confidence interval [95% CI], 1.58-4.82 [P<.001]), T classification (OR, 0.47; 95% CI, 0.24-0.91 [P =.025]), and tumor size (OR, 2.68; 95% CI, 1.48-4.85 [P = .001]) were found to be independently associated with lymph node metastases. There was no lymph node spread noted with Tis tumors. For patients with low-grade (well or moderately differentiated) tumors measuring <2 cm in size, the risk of lymph node metastasis was 1.7% for T1a (P<.001) and 8.6% for T1b (P = .001) tumors. CONCLUSIONS: For patients with low-grade Tis or T1 tumors measuring ≤2 cm in size, the incidence of lymph node metastasis appears to be comparable to the mortality rate associated with esophagectomy. For highly selected patients with early esophageal adenocarcinomas, the results of the current study support the recommendation that local endoscopic resection can be considered as an alternative to surgical management when followed by rigorous endoscopic and radiographic surveillance. Cancer 2016;122:2150-7.
Authors: Christina Oetzmann von Sochaczewski; Thomas Haist; Michael Pauthner; Markus Mann; Susanne Braun; Christian Ell; Dietmar Lorenz Journal: World J Surg Date: 2020-04 Impact factor: 3.352
Authors: Tara R Semenkovich; Jessica L Hudson; Melanie Subramanian; Daniel K Mullady; Bryan F Meyers; Varun Puri; Benjamin D Kozower Journal: Ann Surg Date: 2019-09 Impact factor: 12.969
Authors: Smita Sihag; Sergio De La Torre; Meier Hsu; Tamar Nobel; Kay See Tan; Hans Gerdes; Pari Shah; Manjit Bains; David R Jones; Daniela Molena Journal: J Thorac Cardiovasc Surg Date: 2020-11-24 Impact factor: 6.439
Authors: F J C Ten Kate; S H van Olphen; M J Bruno; B P L Wijnhoven; J J B van Lanschot; L H J Looijenga; R C Fitzgerald; K Biermann Journal: Br J Surg Date: 2017-07-10 Impact factor: 6.939