Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
Ann Surg. 2011 Nov;254(5):731-6; discussion 736-7. doi: 10.1097/SLA.0b013e318236048b.
To accurately document the incidence of lymph node metastases (LNM) in early esophageal adenocarcinoma with regard to the depth of invasion of the mucosa or submucosa.
Endoscopic therapy is now being proposed as a viable treatment for submucosal esophageal adenocarcinoma. If such treatments are appropriate, then the risk of LNM must be shown to be low in these tumors.
One hundred nineteen consecutive patients underwent radical esophagectomy alone for treatment of superficial esophageal adenocarcinoma or high-grade dysplasia. The resection specimens were analyzed by an expert gastrointestinal pathologist and the presence of LNM and the depth of tumor invasion were recorded. Depth of invasion was classified as either confined to the mucosa, the first third of the submucosa, the middle third of the submucosa, or the final third of the submucosa.
Fifty-four patients had high-grade dysplasia or tumors confined to the mucosa with no evidence of LNM (0/54, 0%), 65 patients had tumor invading the submucosa with 8 patients having LNM (8/65, 12%). Subclassification of submucosal invasion showed that 5 of 22 "first third of the submucosa" tumors had LNM (23%), 1 of 24 "middle third of the submucosa" tumors had LNM (4%), and 2 of 19 "final third of the submucosa" tumors had LNM (11%).
Invasion of the submucosa is associated with significant risk of LNM. Patients with submucosal invasion are not suitable for endoscopic treatment and surgical resection remains the gold standard treatment for patients with submucosal adenocarcinoma who are fit to undergo the procedure.
准确记录黏膜或黏膜下浸润深度的早期食管腺癌的淋巴结转移（LNM）发生率。
内镜治疗目前被提议作为黏膜下食管腺癌的一种可行治疗方法。如果这些治疗方法是合适的，那么这些肿瘤的 LNM 风险必须较低。
119 例连续患者仅接受根治性食管切除术治疗浅表性食管腺癌或高级别异型增生。由一位专家胃肠病理学家分析切除标本，记录 LNM 的存在和肿瘤浸润深度。浸润深度分为局限于黏膜、黏膜的前 1/3、黏膜的中 1/3 或黏膜的后 1/3。
54 例患者有高级别异型增生或局限于黏膜的肿瘤，无 LNM 证据（0/54，0%），65 例患者肿瘤侵犯黏膜下，8 例有 LNM（8/65，12%）。黏膜下侵犯的亚分类显示，22 例“黏膜前 1/3”肿瘤中有 5 例有 LNM（23%），24 例“黏膜中 1/3”肿瘤中有 1 例有 LNM（4%），19 例“黏膜后 1/3”肿瘤中有 2 例有 LNM（11%）。
黏膜下侵犯与 LNM 的显著风险相关。黏膜下侵犯的患者不适合内镜治疗，手术切除仍然是适合接受手术的黏膜下腺癌患者的金标准治疗。
