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Risk factors of metastasis in early esophageal adenocarcinoma or cardiac adenocarcinoma involving the esophagus
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Y. Kuribayashi1,
R. Ishihara2,
M. Kaise1 |
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1Department of Gastroenterology, Toranomon Hospital, 2Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases |
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| Aim: To elucidate the indication of endoscopic resection (ER) for early esophageal adenocarcinoma or cardiac adenocarcinoma involving the esophagus, we aimed to demonstrate a detailed metastasis-risk profile in relation to invasion depth and other clinic-pathologic factors. Methods:We conducted a multicenter retrospective study in Japan by 13 high-volume centers, and enrolled 458 patients with early esophageal and cardiac adenocarcinoma, resected by surgery or ER. Metastasis was considered positive if there was histologically or clinically confirmed metastasis in the surgical specimen or was clinically confirmed metastasis during 5-years follow-up in patients treated by ER. Results: (1) 311 (68%) were Barrett's esophagus cancers. A total of 217 patients were surgically resected, and 241 were treated by ER. (2) Metastases were identified in 72 (15.7%) patients. Multivariate analysis confirmed lymphovascular involvement, a poorly differentiated adenocarcinoma component, and lesion size over 30 mm as independent risk factors for metastasis. (3) No metastasis was detected in patients with submucosal cancer (<500 µm) without lymphovascular involvement, a poorly differentiated component, nor 30 mm or less (0/32 patients). Conclusion: lymphovascular involvement, a poorly differentiated adenocarcinoma component, and lesion size over 30 mm were independent risk factors for metastasis in patients with early esophageal and cardiac adenocarcinoma. Mucosal cancer and SM cancer (<500 µm) without these risk factors would be good candidates for ER. |
Index Term 1: early esophageal adenocarcinoma or cardiac adenocarcinoma involving the esophagus
Index Term 2: Risk factors of metastasis |
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