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Lymphovascular invasion and nodal metastasis in intramucosal adenocarcinoma of the esophagus and esophagogastric junction
Author(s) -
Li Zhi Gang,
Zhu Hui,
Shi Hong,
Xie Hao,
Goldblum John R,
Thota Prashanthi N,
Liu Xiuli
Publication year - 2015
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12230
Subject(s) - lymphovascular invasion , medicine , esophagus , adenocarcinoma , esophagectomy , metastasis , pathology , lesion , univariate analysis , barrett's esophagus , gastroenterology , cancer , esophageal cancer , multivariate analysis
Objective To evaluate the tumor parameters predictive of lymphovascular invasion ( LVI ) and nodal metastases in intramucosal adenocarcinoma ( IMAC ) of the esophagus and esophagogastric junction.Methods In all, 171 cases of IMAC from esophagectomy database (1986–2009) were reviewed. LVI was evaluated on HE and by immunohistochemistry stain for D 2‐40 (in selected cases). Univariate analysis was performed to identify predictors for LVI (in this cohort) and nodal metastasis (for pooled data from literature review). Results Altogether 150 IMAC were included in the study after histology review; 7 (4.7%) showed LVI and one (0.7%) had nodal metastasis. LVI ‐positive IMAC were thicker (tumor thickness 3.0 ± 2.8 mm vs 1.3 ± 1.2 mm, P = 0.01), and more likely to invade the outer muscularis mucosae ( M 3) ( P = 0.004), be poorly differentiated ( P < 0.001), and to show a nodular or plaque‐like lesion ( P = 0.04) compared with LVI ‐negative IMAC . Patients' age, gender, the frequency of tumor multifocality, ulceration and tumor size were not significantly different between these two groups. The pooled rates of LVI and nodal metastases in IMAC from five published studies and this cohort were 6.0% (range 2.9–16.7%) and 3.4% (range 0–10.0%), respectively. Pooled analysis of studies with histology review showed that LVI in IMAC was associated with a nodal metastases rate of 27.3%. Conclusion For IMAC of the esophagus and esophagogastric junction, LVI is associated with tumor thickness, M 3 invasion, poor differentiation and the presence of nodular or plaque‐like lesion; by pooled analysis, it is associated with a risk of nodal metastasis of 27.3%.