Impact of Tumor Length and Submucosal Involvement on the Long-Term Survival of pT1 Early Stage Esophageal Adenocarcinoma
William D. Bolton, Wayne Hofstetter, Ashleigh Francis, Arlene M. Correa, Jaffer A. Ajani, Banoop Bhutani, Jeremy Erasmus, Ritsuko Komaki, Dipen Maru, Reza Mehran, David C. Rice, Jack A. Roth, Ara A. Vaporciyan, Garrett L. Walsh, Stephen G. Swisher; Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, TX
Comment on this Abstract
Objective: Recent studies have suggested that submucosal invasion in pT1 early stage esophageal cancer impacts long-term survival and lymph node involvement. The impact of esophageal tumor length on pT1 esophageal cancer has not previously been evaluated.
Methods: All patients (N=129) undergoing esophageal resection from 1985 to 2003 with pT1 adenocarcinoma of the esophagus were reviewed. Resected esophageal tumors were assessed pathologically for submucosal invasion and esophageal tumor length in a craniocaudal dimension. Patients were stratified into three groups based on length and submucosal involvement. Long-term survival was assessed by Kaplan Meier analysis. Univariate and multivariate analyses were performed and compared with other standard prognostic factors including grade and lymph node involvement.
Results: Early stage pT1 esophageal adenocarcinoma patients with tumors > 3 cm and submucosal invasion were found to be at increased risk of lymph node involvement: (Lymph Node Involvement: submucosal + and > 3 cm = 4/9 (44%); submucosal - and > 3 cm or submucosal + and < 3 cm = 13/61 (21%); submucosal - and < 3 cm = 2/59, (3%); p<0.001):
Esophageal tumor length (> 3cm) and submucosal involvement were associated with decreased long-term survival in early stage pT1 adenocarcinoma of the esophagus: (3 yr Survival: submucosal + and > 3 cm = 33%; submucosal + and < 3 cm or submucosal - and > 3 cm = 83%; submucosal - and < 3 cm = 100%, p<0.001).
Multivariable Cox regression analysis showed that esophageal tumor length (> 3 cm) and submucosal involvement were independent risk factors for survival in pT1 early stage esophageal cancer patients (p<0.001, p=0.01) even when controlled for lymph node involvement
Conclusion: This study demonstrates for the first time that tumor length (>3 cm) as well as submucosal involvement are independent risk factors for lymph node involvement and long-term survival in early stage pT1 esophageal adenocarcinoma. Both factors should be utilized to better predict long-term survival and identify high-risk pT1 patients for adjuvant therapy.
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