TY - JOUR
T1 - Pathology of early invasive adenocarcinoma of the esophagus or esophagogastric junction
T2 - Implications for therapeutic decision making
AU - Van Sandick, Johanna W.
AU - Van Lanschot, J. Jan B
AU - Ten Kate, Fiebo J W
AU - Offerhaus, G. Johan A
AU - Fockens, Paul
AU - Tytgat, Guido N J
AU - Obertop, Hugo
PY - 2000/6/1
Y1 - 2000/6/1
N2 - BACKGROUND. As an alternative to surgical resection, endoscopic treatment modalities are being explored for the treatment of patients with early esophageal carcinoma. This study aimed to evaluate patterns of local growth and regional dissemination of early adenocarcinoma of the esophagus or esophagogastric junction, as these pathologic features may contribute to rational therapeutic decision making. METHODS. Among 173 patients who underwent esophageal resection for invasive adenocarcinoma (1993-1998), 32 (19%) had early stage cancer (pT1). Clinical records, pathology reports, and original slides of the surgically resected esophagus were reviewed in each case. RESULTS. In 12 patients tumor invasion was limited to the mucosa, whereas in 20 patients the tumor showed infiltration of the submucosa. All cancers were associated with intestinal metaplasia. Areas of high grade dysplasia accompanied 27 of the 32 cancers (84%). Intramucosal cancer had no lymph node metastasis but presented as multifocal disease in 42% of cases and extended under preexisting squamous mucosa in 17% of cases. In submucosal cancer, lymph node metastases were present in 30% of cases. Disease specific 3-year survival for patients with intramucosal cancer was 100% and for those with submucosal cancer 82% (P = not significant). CONCLUSIONS. Based on the local growth pattern of intramucosal adenocarcinoma of the esophagus or esophagogastric junction, endoscopic treatment of patients with this disease should be applied with caution. For submucosal carcinoma, surgery is the mainstay of treatment, as lymph node metastasis is frequently present. Both subclassifications of early cancer show a favorable outcome after esophagectomy. (C) 2000 American Cancer Society.
AB - BACKGROUND. As an alternative to surgical resection, endoscopic treatment modalities are being explored for the treatment of patients with early esophageal carcinoma. This study aimed to evaluate patterns of local growth and regional dissemination of early adenocarcinoma of the esophagus or esophagogastric junction, as these pathologic features may contribute to rational therapeutic decision making. METHODS. Among 173 patients who underwent esophageal resection for invasive adenocarcinoma (1993-1998), 32 (19%) had early stage cancer (pT1). Clinical records, pathology reports, and original slides of the surgically resected esophagus were reviewed in each case. RESULTS. In 12 patients tumor invasion was limited to the mucosa, whereas in 20 patients the tumor showed infiltration of the submucosa. All cancers were associated with intestinal metaplasia. Areas of high grade dysplasia accompanied 27 of the 32 cancers (84%). Intramucosal cancer had no lymph node metastasis but presented as multifocal disease in 42% of cases and extended under preexisting squamous mucosa in 17% of cases. In submucosal cancer, lymph node metastases were present in 30% of cases. Disease specific 3-year survival for patients with intramucosal cancer was 100% and for those with submucosal cancer 82% (P = not significant). CONCLUSIONS. Based on the local growth pattern of intramucosal adenocarcinoma of the esophagus or esophagogastric junction, endoscopic treatment of patients with this disease should be applied with caution. For submucosal carcinoma, surgery is the mainstay of treatment, as lymph node metastasis is frequently present. Both subclassifications of early cancer show a favorable outcome after esophagectomy. (C) 2000 American Cancer Society.
KW - Adenocarcinoma
KW - Dysplasia
KW - Endoscopic ultrasonography, surgery
KW - Endoscopy
KW - Esophagogastric junction
KW - Esophagus
KW - Intestinal metaplasia
UR - http://www.scopus.com/inward/record.url?scp=0034212382&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0034212382&partnerID=8YFLogxK
U2 - 10.1002/1097-0142(20000601)88:11<2429::AID-CNCR1>3.0.CO;2-H
DO - 10.1002/1097-0142(20000601)88:11<2429::AID-CNCR1>3.0.CO;2-H
M3 - Article
C2 - 10861416
AN - SCOPUS:0034212382
SN - 0008-543X
VL - 88
SP - 2429
EP - 2437
JO - Cancer
JF - Cancer
IS - 11
ER -