Trivedi Anshu, Cartun Richard W, Ligato Saverio
Department of Pathology, Mount Sinai Medical Center, NY, United States.
Department of Pathology, Hartford Hospital, CT, United States.
Pathol Res Pract. 2014 Jul;210(7):402-6. doi: 10.1016/j.prp.2014.01.018. Epub 2014 Mar 13.
A problem in the management of patients with Barrett's esophagus-related pT1 esophageal adenocarcinoma is to distinguish those who should be treated conservatively (endoscopic mucosal resection and/or radiofrequency ablation) from those who require esophago-gastrectomy. Recently, lymphovascular invasion (LVI) has emerged as one of the best predictors of regional lymph node metastasis (LNM) and recurrence-free survival (RFS) in pT1 EAC. However, LVI may be underestimated, both because of interobserver variability and incomplete sampling. The aim of our study was to correlate the presence of LVI, with the immunohistochemical expression of IMP3 in pT1 EAC and assess their role in further stratifying these lesions into high and low risk groups based on the potential for lymph node metastasis and poor outcome.
Depth of invasion, assessed in five sublevels (m2, m3, sm1, sm2, and sm3), LVI, and expression of IMP3 were studied in 30 patients who underwent esophagogastrectomy for pT1 EAC (2001-2010) at Hartford Hospital, and correlated with LNM and RFS. IMP3 was considered positive when expressed in >50% of the malignant cells with an intensity of stain of 2-3+.
Ten of 18 (55.5%) cases with IMP3 expression demonstrated LVI and 2/10 (20%) showed LNM and died of disease. In contrast, none of the 12 IMP3 negative cases showed LVI (p<0.004; 2-tailed Fisher exact test) or had LNM/DOD.
In pT1 EAC, (1) based on IMP3 expression, pT1 EAC may be divided into high risk (LVI+/IMP3+) and low risk (LVI-/IMP3-) categories. (2) Absence of IMP3 expression is associated with a significantly reduced risk of LVI (Negative Predictive Value: 100%). (3) Since identifying lymphovascular invasion and other morphological parameters is prone to significant inter-observer variation, IMP3 may be useful as an ancillary marker especially in these pT1 lesions in predicting their clinical behavior, the risk stratification and potentially on the type of treatment.
巴雷特食管相关的pT1期食管腺癌患者的管理中存在一个问题，即要区分哪些患者应接受保守治疗（内镜黏膜切除术和/或射频消融），哪些患者需要食管胃切除术。最近，淋巴管侵犯（LVI）已成为pT1期食管腺癌区域淋巴结转移（LNM）和无复发生存期（RFS）的最佳预测指标之一。然而，由于观察者间的差异和取样不完整，LVI可能被低估。我们研究的目的是将LVI的存在与pT1期食管腺癌中IMP3的免疫组化表达相关联，并评估它们在根据淋巴结转移可能性和不良预后将这些病变进一步分层为高风险和低风险组中的作用。
对哈特福德医院2001年至2010年因pT1期食管腺癌接受食管胃切除术的30例患者的浸润深度（在五个亚层中评估：m2、m3、sm1、sm2和sm3）、LVI和IMP3的表达进行研究，并与LNM和RFS相关联。当IMP3在>50%的恶性细胞中表达且染色强度为2 - 3+时，被认为是阳性。
18例（55.5%）有IMP3表达的病例中有10例显示LVI，其中2/10（20%）显示LNM并死于疾病。相比之下，12例IMP3阴性病例中无一例显示LVI（p<0.004；双侧Fisher精确检验）或有LNM/死亡。
在pT1期食管腺癌中，（1）根据IMP3表达，pT1期食管腺癌可分为高风险（LVI+/IMP3+）和低风险（LVI-/IMP3-）类别。（2）IMP3表达缺失与LVI风险显著降低相关（阴性预测值：100%）。（3）由于识别淋巴管侵犯和其他形态学参数容易出现显著的观察者间差异，IMP3可能作为一种辅助标志物有用，特别是在这些pT1病变中预测其临床行为、风险分层以及可能的治疗类型。
