Predictors of nodal metastases for clinical T2N0 esophageal adenocarcinoma Journal Article

Authors: Barbetta, A.; Schlottmann, F.; Nobel, T.; Sewell, D. B.; Hsu, M.; Tan, K. S.; Gerdes, H.; Shah, P.; Bains, M. S.; Bott, M.; Isbell, J. M.; Jones, D. R.; Molena, D.
Article Title: Predictors of nodal metastases for clinical T2N0 esophageal adenocarcinoma
Abstract: Background: Induction therapy has not been proven to be beneficial for patients with clinical T2N0 esophageal adenocarcinoma. Surgery alone is associated with disappointing survival for patients found to have nodal disease on final pathologic examination. The aim of this study was to identify factors that predict pathologic nodal involvement in patients with endoscopic ultrasound (EUS)–proven T2N0 esophageal adenocarcinoma. Methods: We retrospectively reviewed patients with EUS-staged T2N0 (uT2N0) esophageal adenocarcinoma treated with surgery alone. Final pathologic staging was compared with clinical staging. Demographic and clinicopathologic variables were evaluated as putative risk factors for nodal metastases. Logistic regression models were used to identify factors associated with nodal involvement. Kaplan-Meier analysis was performed to compare overall and recurrence-free survival between patients with (N+) and without (N−) nodal disease. Results: We identified 80 patients with uT2N0 esophageal adenocarcinoma treated with surgery alone. Clinical staging with EUS was inaccurate for 73 patients (91%). Twenty-eight patients (35%) had pathologic N+ disease at resection. Five-year overall survival was 67% for N− patients and 41% for N+ patients (p = 0.006). Recurrence-free survival was 65% for N− patients and 32% for N+ patients (p = 0.0043). Univariable analysis identified vascular invasion and neural invasion as risk factors for nodal metastasis. Multivariable analysis identified vascular invasion as an independent predictor of pathologic nodal involvement. Conclusions: EUS is inaccurate for staging of T2N0 esophageal adenocarcinoma and often fails to identify nodal involvement. Identification of vascular invasion on preoperative biopsy should be explored as a prognostic marker to select patients for induction therapy. © 2018 The Society of Thoracic Surgeons
Journal Title: Annals of Thoracic Surgery
Volume: 106
Issue: 1
ISSN: 0003-4975
Publisher: Elsevier Science, Inc.  
Date Published: 2018-07-01
Start Page: 172
End Page: 177
Language: English
DOI: 10.1016/j.athoracsur.2018.02.087
PROVIDER: scopus
PUBMED: 29627387
Notes: Article -- Export Date: 2 July 2018 -- Source: Scopus
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MSK Authors
  1. Meier Hsu
    102 Hsu
  2. Hans Gerdes
    122 Gerdes
  3. Matthew Bott
    32 Bott
  4. Manjit S Bains
    219 Bains
  5. Pari Mayank Shah
    22 Shah
  6. David Randolph Jones
    150 Jones
  7. Daniela   Molena
    35 Molena
  8. David Bruce Sewell
    4 Sewell
  9. Kay See   Tan
    68 Tan
  10. James Michael Isbell
    26 Isbell
  11. Tamar B Nobel
    5 Nobel