Prognostic Significance of Lymphovascular Invasion for Thoracic Esophageal Squamous Cell Carcinoma.

OBJECTIVES

This study was designed to demonstrated the prognostic significance of lymphatic and vascular invasion in thoracic esophageal squamous cell carcinoma after curative surgery and establish their predictive role for lymph node metastasis and recurrence in early-stage disease.

METHODS

Clinical data of all patients from 2002 to 2014 who underwent curative surgery for thoracic squamous cell carcinoma were collected from a prospectively maintained database. The association of lymphatic invasion and vascular invasion with clinicopathological variables was illustrated respectively. The effect of lymphatic invasion and vascular invasion on the disease-free survival was determined by Kaplan-Meier analysis stratified by pathological stage. The predictive factors for lymph node metastasis in pT1 tumors and the predictive factors for recurrence in patients without lymph node involvement were analyzed with univariate and multivariate analyses respectively.

RESULTS

Both lymphatic invasion and vascular invasion significantly decreased stage-stratified, disease-free survival (p < 0.001). The independent predictive factors for lymph node metastasis in tumors limited in mucosa and submucosa were: submucosa invasion (p < 0.001, odds ratio [OR] 7.303), lymphatic invasion (p < 0.001, OR 5.031), and tumor differentiation (p = 0.008, OR 1.784). The independent predictive factors for decreased disease-free survival in patients with N0 disease involvement were: lymphatic invasion (p = 0.005, OR 4.326) and deeper tumor invasion (p = 0.001, OR 2.634).

CONCLUSIONS

Lymphatic invasion and vascular invasion are negative prognostic factors independent of tumor stage. Lymphatic invasion is a high-risk factor of lymph node metastasis in T1 tumors and a high-risk factor of recurrence in patients without lymph node involvement.