Journal of surgical oncology · 2025
Analysis of the Incidence of Lymph Node Metastases in High-Risk Early Stage (T1) Esophageal Adenocarcinomas: A Single-Institution Experience.
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Shannon Adrienne B, Mohammed Marwa A, Lauwers Gregory Y, Pena Luis R, Mok Shaffer R, Sinnamon Andrew J, Araujo Cyrillo R, Pimiento Jose M
Аннотация
INTRODUCTION: The incidence of lymph node metastasis (LNM) in early stage esophageal adenocarcinoma (EAC) is up to 45% based on high-risk pathologic features. This risk has not been determined following external validation of staging and pathologic features.
METHODS: Patients with clinical T1 EAC who underwent surgical resection at a single institution from 1999 to 2023 were included. Before inclusion, all retrospective data was validated by an external reviewer within the institution. Patients were categorized into low-risk and high-risk categories. Incidence of LNM was examined using univariate analyses. Survival analysis was performed with Kaplan Meier survival estimates.
RESULTS: 66 patients underwent esophagectomy and had multidisciplinary validation of staging and pathologic data; 28 (42.4%) patients had pT1b and 11/28 (39.3%) had SM3 tumors. The LNM rate was 10.6%; the incidence of LNM was higher for T1b compared to T1a (17.9%, N = 5/28 vs 5.3%, N = 2/38, p 0.10) tumors. Low-risk pT1a and high-risk pT1b patients had a LNM rates of 3.3% and 21.7%, respectively. Following a median follow-up of 46 months, there was no significant difference in overall survival and recurrence-free survival across risk stratification groups and comparing patients with and without LNM. Sensitivity for staging of T1b tumors was poor (40.9%, 50%, and 82.1%, respectively) for chest/abdominal CT, PET/CT, and EUS.
CONCLUSION: T1 EAC patients retrospectively reviewed for multidisciplinary validation of staging and pathologic data have a LNM risk up to 21.7% when stratified by risk factors with a clinical trend toward worse survival. High-risk T1b patients may warrant neoadjuvant chemoradiotherapy before surgical resection.
METHODS: Patients with clinical T1 EAC who underwent surgical resection at a single institution from 1999 to 2023 were included. Before inclusion, all retrospective data was validated by an external reviewer within the institution. Patients were categorized into low-risk and high-risk categories. Incidence of LNM was examined using univariate analyses. Survival analysis was performed with Kaplan Meier survival estimates.
RESULTS: 66 patients underwent esophagectomy and had multidisciplinary validation of staging and pathologic data; 28 (42.4%) patients had pT1b and 11/28 (39.3%) had SM3 tumors. The LNM rate was 10.6%; the incidence of LNM was higher for T1b compared to T1a (17.9%, N = 5/28 vs 5.3%, N = 2/38, p 0.10) tumors. Low-risk pT1a and high-risk pT1b patients had a LNM rates of 3.3% and 21.7%, respectively. Following a median follow-up of 46 months, there was no significant difference in overall survival and recurrence-free survival across risk stratification groups and comparing patients with and without LNM. Sensitivity for staging of T1b tumors was poor (40.9%, 50%, and 82.1%, respectively) for chest/abdominal CT, PET/CT, and EUS.
CONCLUSION: T1 EAC patients retrospectively reviewed for multidisciplinary validation of staging and pathologic data have a LNM risk up to 21.7% when stratified by risk factors with a clinical trend toward worse survival. High-risk T1b patients may warrant neoadjuvant chemoradiotherapy before surgical resection.