Liu Lixia, Hofstetter Wayne L, Rashid Asif, Swisher Stephen G, Correa Arlene M, Ajani Jaffer A, Hamilton Stanley R, Wu Tsung-Teh
Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
Am J Surg Pathol. 2005 Aug;29(8):1079-85.
Superficially invasive esophageal adenocarcinomas are a heterogeneous group of tumors, including tumors invading into mucosa and submucosa. The prognostic significance of the depth of tumor invasion and lymph node status in this group of patients remain unclear. We evaluated 90 consecutive patients with resected T1 adenocarcinoma of esophagus or esophagogastric junction. The T1 tumors were classified into four groups based on the depth of invasion: T1a, invading into lamina propria; T1b, into muscularis mucosae; T1c, into superficial submucosa; and T1d, into deep submucosa. The depth of tumor invasion was compared with clinicopathologic features. The depth of tumor invasion was significantly associated with the presence of lymph node metastasis (36% in T1d, 8% in T1c, 12% in T1b, and 0% in T1a; P < 0.001) and with tumor size (76% > 1.2 cm in T1d, 75% in T1c, 35% in T1b, and 25% in T1a; P < 0.001). The 5-year recurrence-free and overall survivals were significantly better in patients with tumors confined to mucosa (100% and 91%, respectively) than invasive into submucosa (60% and 58%; P = 0.0005 and P = 0.02, respectively). Lymph node metastasis was associated with tumor recurrence (P = 0.01) but not overall survival. Lymphovascular invasion was associated with both tumor recurrence (P = 0.001) and overall survival (P < 0.001) and was an independent prognostic factor in multivariate analysis (P = 0.04). Our study indicated evaluation of depth of tumor invasion, status of lymph nodes, and lymphovascular invasion is important in resected superficially invasive esophageal adenocarcinoma and may provide supportive information for the decision about postoperative adjuvant therapy.
表浅浸润性食管腺癌是一组异质性肿瘤，包括侵犯黏膜和黏膜下层的肿瘤。该组患者中肿瘤浸润深度和淋巴结状态的预后意义仍不明确。我们评估了90例连续接受食管或食管胃交界部T1期腺癌切除术的患者。根据浸润深度，T1期肿瘤分为四组：T1a，侵犯固有层；T1b，侵犯黏膜肌层；T1c，侵犯浅黏膜下层；T1d，侵犯深黏膜下层。将肿瘤浸润深度与临床病理特征进行比较。肿瘤浸润深度与淋巴结转移显著相关（T1d为36%，T1c为8%，T1b为12%，T1a为0%；P<0.001），也与肿瘤大小相关（T1d中76%>1.2 cm，T1c中75%，T1b中35%，T1a中25%；P<0.001）。肿瘤局限于黏膜的患者5年无复发生存率和总生存率（分别为100%和91%）明显优于侵犯黏膜下层的患者（分别为60%和58%；P分别为0.0005和0.02）。淋巴结转移与肿瘤复发相关（P=0.01），但与总生存率无关。淋巴管浸润与肿瘤复发（P=0.001）和总生存率（P<0.001）均相关，并且在多因素分析中是独立的预后因素（P=0.04）。我们的研究表明，评估肿瘤浸润深度、淋巴结状态和淋巴管浸润对于接受手术切除的表浅浸润性食管腺癌很重要，可能为术后辅助治疗的决策提供支持性信息。
