Christina Oetzmann von Sochaczewski1, Thomas Haist2, Michael Pauthner2, Markus Mann2, Susanne Braun3, Christian Ell4, Dietmar Lorenz5. 1. Department of Paediatric Surgery, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Germany. 2. Department of Surgery I, Sana Klinikum Offenbach, Offenbach, Germany. 3. Institute of Pathology, Sana Klinikum Offenbach, Offenbach, Germany. 4. Department of Internal Medicine II, Sana Klinikum Offenbach, Offenbach, Germany. 5. Department of Surgery I, Klinikum Darmstadt, Grafenstraße 9, 64283, Darmstadt, Germany. dietmar.lorenz@mail.klinikum-darmstadt.de.
Abstract
BACKGROUND: Research in early esophageal adenocarcinoma focused on prediction of lymph node metastases in order to stratify patients for endoscopic treatment instead of esophagectomy. Although distant metastases were described in rates of up to 13% of patients within a follow-up of 3 years, their prediction has been neglected so far. METHODS: In a secondary analysis, a cohort of 217 patients (53 T1a and 164 T1b) treated by esophagectomy was analyzed for histopathological risk factors. Their ability to predict the combination of lymph node metastases at surgery as well as metachronous locoregional and distant metastases (overall metastatic rate) was assessed by uni- and multivariate logistic regression analysis. RESULTS: Tumor invasion depth was correlated with both lymph node metastases at surgery (τ = 0.141; P = .012), tumor recurrences (τ = 0.152; P = .014), and distant metastases (τ = 0.122; P = 0.04). Multivariate analysis showed an odds ratio of 1.31 (95% CI 1.02-1.67; P = .033) per increasing tumor invasion depth and of 3.5 (95% CI 1.70-6.56; P < .001) for lymphovascular invasion. The pre-planned subgroup analysis in T1b tumors demonstrated an even lower predictive ability of lymphovascular invasion with an odds ratio of 2.5 (95% CI 1.11-5.65; P = 0.028), whereas the predictive effect of sm2 (odds ratio 3.44; 95% CI 1.00-11.9; P = 0.049) and sm3 (odds ratio 3.44; 95% CI 1.00-11.9; P = 0.049) tumor invasion depth was similar. CONCLUSIONS: The present report demonstrates the insufficient risk prediction of histopathologic risk factors for the overall metastatic rate.
BACKGROUND: Research in early esophageal adenocarcinoma focused on prediction of lymph node metastases in order to stratify patients for endoscopic treatment instead of esophagectomy. Although distant metastases were described in rates of up to 13% of patients within a follow-up of 3 years, their prediction has been neglected so far. METHODS: In a secondary analysis, a cohort of 217 patients (53 T1a and 164 T1b) treated by esophagectomy was analyzed for histopathological risk factors. Their ability to predict the combination of lymph node metastases at surgery as well as metachronous locoregional and distant metastases (overall metastatic rate) was assessed by uni- and multivariate logistic regression analysis. RESULTS:Tumor invasion depth was correlated with both lymph node metastases at surgery (τ = 0.141; P = .012), tumor recurrences (τ = 0.152; P = .014), and distant metastases (τ = 0.122; P = 0.04). Multivariate analysis showed an odds ratio of 1.31 (95% CI 1.02-1.67; P = .033) per increasing tumor invasion depth and of 3.5 (95% CI 1.70-6.56; P < .001) for lymphovascular invasion. The pre-planned subgroup analysis in T1b tumors demonstrated an even lower predictive ability of lymphovascular invasion with an odds ratio of 2.5 (95% CI 1.11-5.65; P = 0.028), whereas the predictive effect of sm2 (odds ratio 3.44; 95% CI 1.00-11.9; P = 0.049) and sm3 (odds ratio 3.44; 95% CI 1.00-11.9; P = 0.049) tumor invasion depth was similar. CONCLUSIONS: The present report demonstrates the insufficient risk prediction of histopathologic risk factors for the overall metastatic rate.
Authors: Marinke Westerterp; Linetta B Koppert; Christianne J Buskens; Hugo W Tilanus; Fiebo J W ten Kate; Jacques J H G M Bergman; Peter D Siersema; Herman van Dekken; Jan J B van Lanschot Journal: Virchows Arch Date: 2005-04-19 Impact factor: 4.064
Authors: Anthony M Gamboa; Sungjin Kim; Seth D Force; Charles A Staley; Kevin E Woods; David A Kooby; Shishir K Maithel; Jennifer A Luke; Katherine M Shaffer; Sunil Dacha; Nabil F Saba; Steven A Keilin; Qiang Cai; Bassel F El-Rayes; Zhengjia Chen; Field F Willingham Journal: Cancer Date: 2016-05-03 Impact factor: 6.860
Authors: C Oetzmann von Sochaczewski; T Haist; M Pauthner; M Mann; A Fisseler-Eckhoff; S Braun; C Ell; D Lorenz Journal: Dis Esophagus Date: 2019-11-13 Impact factor: 3.429