Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Clin Gastroenterol Hepatol. 2010 Mar;8(3):248-53. doi: 10.1016/j.cgh.2009.11.016. Epub 2009 Nov 27.
BACKGROUND & AIMS: There is controversy over the outcomes of esophageal adenocarcinoma with superficial submucosal invasion. We evaluated the impact of depth of submucosal invasion on the presence of metastatic lymphadenopathy and survival in patients with esophageal adenocarcinoma.
Pathology reports of esophagectomy samples collected from 1997 to 2007 were reviewed. Specimens from patients with esophageal adenocarcinoma and submucosal invasion were reviewed and classified as superficial (upper 1 third, sm1) or deep (middle third, sm2 or deepest third, sm3) invasion. Outcomes studied were presence of metastatic lymphadenopathy and overall survival. Variables of interest were analyzed as factors that affect overall and cancer-free survival using Cox proportional hazards modeling. A multivariate model was constructed to establish independent associations with survival.
The study included 80 patients; 31 (39%) had sm1 carcinoma, 23 (29%) had sm2 carcinoma, and 26 (33%) had sm3 carcinoma. Superficial and deep submucosal invasion were associated with substantial rates of metastatic lymphadenopathy (12.9% and 20.4%, respectively). The mean follow-up time was 40.5 +/- 4 months and the mean overall unadjusted survival time was 53.8 +/- 4.1 months. Factors significantly associated with reduced survival time included the presence of metastatic lymph nodes (hazard ratio [HR], 2.89; confidence interval [CI], 1.13-6.88) and esophageal cancer recurrence (HR 6.39, CI 2.40-16.14), but not depth of submucosal invasion.
Patients with sm1 esophageal carcinoma have substantial rates of metastatic lymphadenopathy. Endoscopic treatment of superficial submucosal adenocarcinoma is not advised for patients that are candidates for surgery.
食管腺癌伴黏膜下浅层浸润的预后存在争议。本研究评估了黏膜下浸润深度对食管腺癌患者淋巴结转移和生存的影响。
回顾了 1997 年至 2007 年间收集的食管切除术标本的病理报告。对有黏膜下侵犯的食管腺癌标本进行了复习和分类，分为黏膜浅层（上 1/3，sm1）或深层（中 1/3，sm2 或最深层，sm3）侵犯。研究的结果是淋巴结转移和总生存情况。使用 Cox 比例风险模型分析了感兴趣的变量作为影响总生存和无癌生存的因素。建立了一个多变量模型来确定与生存相关的独立因素。
研究共纳入 80 例患者；31 例（39%）为 sm1 癌，23 例（29%）为 sm2 癌，26 例（33%）为 sm3 癌。黏膜浅层和深层侵犯与较高的淋巴结转移率（分别为 12.9%和 20.4%）相关。平均随访时间为 40.5±4 个月，平均总无调整生存时间为 53.8±4.1 个月。与生存时间缩短显著相关的因素包括存在淋巴结转移（风险比[HR]，2.89；95%可信区间[CI]，1.13-6.88）和食管癌复发（HR 6.39，95%CI 2.40-16.14），而与黏膜下浸润深度无关。
sm1 食管腺癌患者有较高的淋巴结转移率。内镜治疗不建议用于有手术适应证的黏膜下浅层腺癌患者。
