Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Los Angeles, CA 90033, USA.
Ann Surg. 2011 Feb;253(2):271-8. doi: 10.1097/SLA.0b013e3181fbad42.
Knowledge of the risk of lymph node metastases is critical to planning therapy for T1 esophageal adenocarcinoma. This study retrospectively reviews 75 T1a and 51 T1b tumors and correlates lymph node metastases with depth of tumor invasion, tumor size, presence of lymphovascular invasion, and tumor grade.
Increasingly, patients with superficial esophageal adenocarcinoma are being treated endoscopically or with limited surgical resection techniques. Since no lymph nodes are removed with these therapies, it is critical to have a clear understanding of the risk of lymph node metastases in these patients. The aim of this study was to define the risk of lymph node metastases for intramucosal and submucosal (T1) esophageal adenocarcinoma and to analyze factors potentially associated with an increased risk of lymph node involvement.
We reanalyzed the pathology specimens of all patients that had primary esophagectomy for T1 adenocarcinoma of the distal esophagus or gastroesophageal junction from January 1985 to December 2008. The prevalence of lymph node metastases was correlated with tumor size, depth of invasion, presence of lymphovascular invasion, and degree of tumor differentiation.
There were 126 patients, 102 men (81%) and 24 women (19%), with a mean age of 64 (± 10) years. Tumor invasion was limited to the mucosa (T1a) in 75 patients (60%), whereas submucosal invasion (T1b) was present in 51 patients (40%). Tumors that had poor differentiation, lymphovascular invasion, and size ≥2 cm were significantly more likely to be invasive into the submucosa. Lymph node metastases were rare (1.3%) with intramucosal tumors but increased significantly with submucosal tumor invasion (22%)[P = 0.0003]. Lymph node metastases were also significantly associated with poor differentiation (P = 0.0015), lymphovascular invasion (P < 0.0001), and tumor size ≥2 cm (P = 0.01). Division of the submucosa into thirds did not show a layer with a significantly decreased prevalence of node metastases.
Adenocarcinoma invasive deeper than the muscularis mucosa is associated with a significant increase in the prevalence of lymph node metastases,and there is no "safe" level of invasion into the submucosa. Lymphovascular invasion, tumor size ≥2 cm, and poor differentiation are associated with an increased risk of submucosal invasion and lymph node metastases and should be factored into the decision for endoscopic therapy or esophagectomy
了解淋巴结转移的风险对于 T1 食管腺癌的治疗计划至关重要。本研究回顾性分析了 75 例 T1a 期和 51 例 T1b 期肿瘤，并将淋巴结转移与肿瘤浸润深度、肿瘤大小、淋巴管血管侵犯和肿瘤分级相关联。
越来越多的浅表性食管腺癌患者接受内镜治疗或有限的手术切除技术治疗。由于这些治疗方法不切除淋巴结，因此必须清楚了解这些患者发生淋巴结转移的风险。本研究的目的是确定黏膜内和黏膜下（T1）食管腺癌的淋巴结转移风险，并分析与淋巴结受累风险增加相关的潜在因素。
我们重新分析了 1985 年 1 月至 2008 年 12 月期间因远端食管或胃食管交界处 T1 腺癌接受原发性食管切除术的所有患者的病理标本。淋巴结转移的发生率与肿瘤大小、浸润深度、淋巴管血管侵犯和肿瘤分化程度相关联。
共有 126 例患者，102 例男性（81%）和 24 例女性（19%），平均年龄为 64（±10）岁。75 例（60%）肿瘤局限于黏膜（T1a），51 例（40%）肿瘤侵犯黏膜下层（T1b）。分化差、淋巴管血管侵犯和肿瘤大小≥2cm 的肿瘤更有可能侵犯黏膜下层。黏膜内肿瘤淋巴结转移罕见（1.3%），但黏膜下肿瘤侵犯时显著增加（22%）[P=0.0003]。淋巴结转移也与分化差（P=0.0015）、淋巴管血管侵犯（P<0.0001）和肿瘤大小≥2cm（P=0.01）显著相关。将黏膜下层分为三分之一并没有显示出淋巴结转移发生率显著降低的层。
浸润超过黏膜肌层的腺癌与淋巴结转移的发生率显著增加相关，并且黏膜下没有“安全”的浸润水平。淋巴管血管侵犯、肿瘤大小≥2cm 和分化差与黏膜下侵犯和淋巴结转移的风险增加相关，应纳入内镜治疗或食管切除术的决策因素。
