Ryu Ishihara1, Tsuneo Oyama2, Seiichiro Abe3, Hiroaki Takahashi4, Hiroyuki Ono5, Junko Fujisaki6, Mitsuru Kaise7, Kenichi Goda8, Kenro Kawada9, Tomoyuki Koike10, Manabu Takeuchi11, Rie Matsuda12, Dai Hirasawa13, Masayoshi Yamada3, Junichi Kodaira4, Masaki Tanaka5, Masami Omae6, Akira Matsui7, Takashi Kanesaka14, Akiko Takahashi2, Shinichi Hirooka15, Masahiro Saito10, Yosuke Tsuji12, Yuki Maeda13, Hiroharu Yamashita16, Ichiro Oda3, Yasuhiko Tomita17, Takashi Matsunaga18, Shuji Terai11, Soji Ozawa19, Tatsuyuki Kawano9, Yasuyuki Seto16. 1. Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-3 Nakamichi 1-chome, Higashinari-ku, Osaka, 537-8511, Japan. isihara-ry@mc.pref.osaka.jp. 2. Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan. 3. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan. 4. Department of Gastroenterology, Keiyukai Daini Hospital, Sapporo, Japan. 5. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan. 6. Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan. 7. Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan. 8. Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan. 9. Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan. 10. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. 11. Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan. 12. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 13. Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan. 14. Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-3 Nakamichi 1-chome, Higashinari-ku, Osaka, 537-8511, Japan. 15. Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan. 16. Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan. 17. Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. 18. Department of Medical Informatics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. 19. Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan.
Abstract
BACKGROUND: Little is known about the specific risks of metastasis in esophageal adenocarcinoma in relation to invasion depth or other pathologic factors. METHODS: We conducted a multicenter retrospective study in 13 high-volume centers in Japan from January 2000 to October 2014 to elucidate the risk of metastasis of esophageal adenocarcinoma. A total of 458 patients (217 surgically resected and 241 endoscopically resected) with esophageal adenocarcinoma or esophagogastric adenocarcinoma involving the esophagus were included. Metastasis was considered positive if there was histologically confirmed metastasis in the surgical specimen or clinically confirmed metastasis during follow-up. Metastasis was considered negative if no metastasis was identified in resected specimens and during follow-up in patients treated surgically or no metastasis during follow-up for >5 years in patients treated by endoscopic resection. RESULTS: Metastasis was identified in 72 patients. Multivariate analysis confirmed lymphovascular involvement [odds ratio (OR) 6.20; 95 % confidence interval (CI) 3.12-12.32; p < 0.001], a poorly differentiated component (OR 3.69; 95 % CI 1.92-7.10; p < 0.001), and lesion size >30 mm (OR 3.12; 95 % CI 1.63-5.97; p = 0.001) as independent risk factors for metastasis. No metastasis was detected in patients with mucosal cancer without lymphovascular involvement and a poorly differentiated component (0/186 lesions) or in patients with cancer invading the submucosa (1-500 µm) without lymphovascular involvement, a poorly differentiated component, and ≤30 mm (0/32 lesions). CONCLUSIONS: Mucosal and submucosal cancers (1-500 µm invasion) without risk factors have a low incidence of metastasis and may thus be good candidates for endoscopic resection.
BACKGROUND: Little is known about the specific risks of metastasis in esophageal adenocarcinoma in relation to invasion depth or other pathologic factors. METHODS: We conducted a multicenter retrospective study in 13 high-volume centers in Japan from January 2000 to October 2014 to elucidate the risk of metastasis of esophageal adenocarcinoma. A total of 458 patients (217 surgically resected and 241 endoscopically resected) with esophageal adenocarcinoma or esophagogastric adenocarcinoma involving the esophagus were included. Metastasis was considered positive if there was histologically confirmed metastasis in the surgical specimen or clinically confirmed metastasis during follow-up. Metastasis was considered negative if no metastasis was identified in resected specimens and during follow-up in patients treated surgically or no metastasis during follow-up for >5 years in patients treated by endoscopic resection. RESULTS: Metastasis was identified in 72 patients. Multivariate analysis confirmed lymphovascular involvement [odds ratio (OR) 6.20; 95 % confidence interval (CI) 3.12-12.32; p < 0.001], a poorly differentiated component (OR 3.69; 95 % CI 1.92-7.10; p < 0.001), and lesion size >30 mm (OR 3.12; 95 % CI 1.63-5.97; p = 0.001) as independent risk factors for metastasis. No metastasis was detected in patients with mucosal cancer without lymphovascular involvement and a poorly differentiated component (0/186 lesions) or in patients with cancer invading the submucosa (1-500 µm) without lymphovascular involvement, a poorly differentiated component, and ≤30 mm (0/32 lesions). CONCLUSIONS:Mucosal and submucosal cancers (1-500 µm invasion) without risk factors have a low incidence of metastasis and may thus be good candidates for endoscopic resection.
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