Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
Ann Surg. 2011 Nov;254(5):802-7; discussion 807-8. doi: 10.1097/SLA.0b013e3182369128.
To identify differences in survival of patients with pT1 esophageal cancer relating to depth of wall infiltration.
Histologic analysis of mucosal and submucosal infiltration in thirds has shown an increasing rate of lymph node metastases (LNM) according to the depth of wall infiltration in pT1 esophageal cancer.
One hundred seventy-one patients had transthoracic en bloc (n = 161) or transhiatal esophagectomy (n = 10) for pT1 esophageal cancer [121 adenocarcinomas (AC), 50 squamous cell carcinomas (SCC)]. The histologic analysis of the specimen comprised depth of wall penetration of the carcinoma in thirds of pT1a = mucosa (m1, m2, m3) or pT1b = submucosa (sm1, sm2, sm3) and number and infiltration of the resected lymph nodes.
The rate of LNM was 0% for 70 mucosal carcinomas and 34% for 101 submucosal carcinomas (P = 0.001). For sm1, this rate was 13%, for sm2 19% and for sm3 56%. The 5-year survival rate (5Y-SR) was 82% for pN0 and 45% for pN+ patients (P < 0.001). There was no significant prognostic difference between AC and SCC (5Y-SR: 74% vs 71%). The 5Y-SR of the pT1a group was 87% compared with 66% for pT1b (P = 0.046). The 5-year survival rate for sm1 and sm2 were similar; sm1 + sm2 were together significantly better (80%) than sm3 (46%) (P = 0.008). In multivariate analysis, only sm3 was an independent prognostic factor (P = 0.01).
After esophagectomy, the prognosis of patients with sm1/sm2 infiltration is as good as for patients with mucosal carcinoma. Sm3 infiltration is the worst prognostic factor in pT1 esophageal cancer.
确定与肿瘤浸润深度相关的 pT1 食管癌患者生存差异。
黏膜和黏膜下浸润的组织学分析显示，pT1 食管癌的肿瘤壁浸润深度与淋巴结转移（LNM）率呈正相关。
171 例患者行经胸整块切除术（n=161）或经食管裂孔切除术（n=10）治疗 pT1 食管癌[121 例腺癌（AC），50 例鳞癌（SCC）]。标本的组织学分析包括 pT1a 癌的壁浸润深度（m1、m2、m3）或 pT1b 癌的黏膜下浸润深度（sm1、sm2、sm3）以及切除淋巴结的数量和浸润情况。
70 例黏膜癌的 LNM 率为 0%，101 例黏膜下癌的 LNM 率为 34%（P=0.001）。sm1 的 LNM 率为 13%，sm2 为 19%，sm3 为 56%。pN0 患者的 5 年生存率（5Y-SR）为 82%，pN+患者的 5Y-SR 为 45%（P<0.001）。AC 和 SCC 之间的预后差异无统计学意义（5Y-SR：74%vs71%）。pT1a 组的 5Y-SR 为 87%，pT1b 组为 66%（P=0.046）。sm1 和 sm2 的 5Y-SR 相似，sm1+sm2 明显优于 sm3（80% vs46%）（P=0.008）。多因素分析显示，只有 sm3 是独立的预后因素（P=0.01）。
食管癌根治术后，sm1/sm2 浸润患者的预后与黏膜癌患者相似。sm3 浸润是 pT1 食管癌预后最差的因素。
