Elsevier

The Annals of Thoracic Surgery

Volume 96, Issue 5, November 2013, Pages 1840-1845
The Annals of Thoracic Surgery

Original article
General thoracic
pT2 Adenocarcinoma of the Esophagus: Early or Advanced Cancer?

https://doi.org/10.1016/j.athoracsur.2013.05.086Get rights and content

Background

There is an increasing trend to include patients with esophageal carcinoma invading the muscularis propria (pT2) in neoadjuvant therapy regimens. But it is unclear which patients have prognostic benefit from this strategy. The aim of this study was to assess the prognosis and prognostic factors in patients with pT2 esophageal adenocarcinoma to further optimize treatment strategies.

Methods

Included were patients with pT2 esophageal adenocarcinoma treated operatively at three centers specializing in upper gastrointestinal surgery. There were 159 patients (139 male) without induction therapy; median age was 64.5 years. Survival was analyzed by univariate and multivariate analysis.

Results

In 37% of patients (n = 59), no lymph node involvement (pN0) was detected. Overall 5-year survival rate for all patients was 37%; for pN0 patients it was 62%, and for patients with lymph node metastases (pN+) it was 24%. Median number of examined lymph nodes was 26. Extracapsular lymph node involvement (ELNI) was evident in 55 of 100 pN+ patients with a 5-year survival rate of 14%. Patients without ELNI had a 5-year survival rate of 36% (p = 0.041). Results were comparable in all participating hospitals. Thirty-day and 90-day mortality rates of the entire collective were 2.6% and 3.8%, respectively. Multivariate analysis of prognosis revealed the lymph node ratio (p < 0.001) and the pN-ELNI category (p = 0.005) as significant parameters (pN0 hazard ratio 1 [reference]; pN+ without ELNI hazard ratio 2.2, 95% confidence interval: 1.2 to 3.8); pN+ with ELNI hazard ratio 2.5, 95% confidence interval: 1.5 to 4.5).

Conclusions

The prognosis of patients with esophageal adenocarcinoma invading the muscularis propria without lymph node metastasis is very good. However, in this study, about 30% had extracapsular lymph node involvement, which reflects particularly aggressive biological tumor behavior.

Section snippets

Patients

One hundred fifty-nine patients with pT2 adenocarcinoma of the esophagus were included in this retrospective study. The patients were treated in three high-volume centers for upper gastrointestinal surgery between July 1, 1996, and June 30, 2010. Only patients without neoadjuvant therapy were included. Relevant patient characteristics are summarized in Table 1. The study was approved by the Local Ethics Committee of the three hospitals.

Surgical Resection

Surgical treatment of choice was subtotal en bloc

Demographics

One hundred fifty-nine patients not undergoing neoadjuvant therapy were included in this study. The median age of the 159 patients was 64.5 years (minimum 36, maximum 84). The demographics and prognostic factors for the patients are shown in Table 1. There were no significant differences among the three surgical centers according to age of the patients (p = 0.882), sex (p = 0.259), pN category (p = 0.638), pM category (p = 0.923), R category (p = 0.469), or follow-up of the patients (p = 0.234).

Comment

In this study, we could show that patients with adenocarcinoma of the esophagus limited to the muscularis propria and no lymphatic tumor invasion (pT2pN0) have a very good prognosis with a median survival rate of more than 8 years. The 5-year survival rate of 62% is lower than that of published data for patients with “early" adenocarcinoma of the esophagus at approximately 74% [2]. In our series, the prognosis for patients with pT2pN0 carcinoma is comparable to data from 66 patients with

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