Prediction of appropriateness of local endoscopic treatment for high-grade dysplasia and early adenocarcinoma by EUS and histopathologic features

被引:222
作者
Buskens, CJ [1 ]
Westerterp, M [1 ]
Lagarde, SM [1 ]
Bergman, JJGHM [1 ]
ten Kate, FJW [1 ]
van Lanschot, JJB [1 ]
机构
[1] Acad Med Ctr, Dept Surg, NL-1105 AZ Amsterdam, Netherlands
关键词
D O I
10.1016/S0016-5107(04)02017-6
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: Endoscopic techniques are being developed for the local treatment of early stage esophageal cancer. However, such therapy is not appropriate for patients with lymph node metastasis. The aim of this study was to analyze the histopathologic features of high-grade dysplasia and early stage adenocarcinoma and to relate these to lymph node involvement. Methods: Pathology reports were reviewed for all 367 patients who underwent subtotal esophagectomy for high-grade dysplasia or adenocarcinoma of the esophagus or the gastroesophageal junction between January 1993 and December 2001. Patients with histopathologically confirmed high-grade dysplasia or T1 carcinoma were included (n = 77). Pre-operative EUS results were assessed. All lesions were histopathologically subdivided in 6 different stages (mucosal 1-3 and submucosal 1-3). Results: EUS staged 61 patients as NO. EUS correctly predicted the absence of positive lymph nodes in 57 (93%) of these patients. Histopathologically, m1, m2, m3, and sm1 cancers never had lymph node metastases, whereas 3 of 13 sm2 tumors (23%) and 9 of 13 sm3 tumors (69%) had lymph node involvement. Lymphangio invasion was present exclusively in sm2 and sm3 cancers. Factors that predicted the presence of lymph node metastasis were the following: tumor diameter greater than 3 cm, infiltration of malignancy beyond sm1, poor differentiation grade, and lymphangio invasion, although only infiltration beyond sm1 remained significant in the definitive multivariate analysis. Conclusions: EUS and the histopathologic features of high-grade dysplasia and early stage adenocarcinoma of the esophagus or the gastroesophageal junction can predict the presence of lymph node involvement. These data can be used to identify patients for whom local endoscopic treatment may be appropriate.
引用
收藏
页码:703 / 710
页数:8
相关论文
共 48 条
[1]   Pathologic features of superficial esophageal squamous cell carcinoma with lymph node and distal metastasis [J].
Araki, K ;
Ohno, S ;
Egashira, A ;
Saeki, H ;
Kawaguchi, H ;
Sugimachi, K .
CANCER, 2002, 94 (02) :570-575
[2]   RISING INCIDENCE OF ADENOCARCINOMA OF THE ESOPHAGUS AND GASTRIC CARDIA [J].
BLOT, WJ ;
DEVESA, SS ;
KNELLER, RW ;
FRAUMENI, JF .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1991, 265 (10) :1287-1289
[3]  
Bonavina L, 1997, Dis Esophagus, V10, P162
[4]  
Bytzer P, 1999, AM J GASTROENTEROL, V94, P86
[5]   Methylene blue-directed biopsies improve detection of intestinal metaplasia and dysplasia in Barrett's esophagus [J].
Canto, MIF ;
Setrakian, S ;
Willis, J ;
Chak, A ;
Petras, R ;
Powe, NR ;
Sivak, MV .
GASTROINTESTINAL ENDOSCOPY, 2000, 51 (05) :560-568
[6]   Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus [J].
Ell, C ;
May, A ;
Gossner, L ;
Pech, O ;
Günter, E ;
Mayer, G ;
Henrich, R ;
Vieth, M ;
Müller, H ;
Seitz, G ;
Stolte, M .
GASTROENTEROLOGY, 2000, 118 (04) :670-677
[7]  
Endo M, 1997, Dis Esophagus, V10, P155
[8]   Outcomes of minimally invasive esophagectomy (MIE) for high-grade dysplasia of the esophagus [J].
Fernando, HC ;
Luketich, JD ;
Buenaventura, PO ;
Perry, Y ;
Christie, NA .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2002, 22 (01) :1-6
[9]   THE EUROPEAN-EXPERIENCE WITH ESOPHAGEAL CANCER LIMITED TO THE MUCOSA AND SUBMUCOSA [J].
FROELICHER, P ;
MILLER, G .
GASTROINTESTINAL ENDOSCOPY, 1986, 32 (02) :88-90
[10]   Optimum treatment strategy for superficial esophageal cancer: Endoscopic mucosal resection versus radical esophagectomy [J].
Fujita, H ;
Sueyoshi, S ;
Yamana, H ;
Shinozaki, K ;
Toh, U ;
Tanaka, Y ;
Mine, T ;
Kubota, M ;
Shirouzu, K ;
Toyonaga, A ;
Harada, H ;
Ban, S ;
Watanabe, M ;
Toda, Y ;
Tabuchi, E ;
Hayabuchi, N ;
Inutsuka, H .
WORLD JOURNAL OF SURGERY, 2001, 25 (04) :424-431