Universität zu Köln

Metzger, Ralf, Lorenz, Dietmar, Gockel, Ines, Origer, Judith, Plum, Patrick S. ORCID: 0000-0002-8165-4553, Junginger, Theodor, Drebber, Uta, Hansen, Torsten, Kruempelmann, Kristina, Fisseler-Eckhoff, Annette, Lang, Hauke, Hoelscher, Arnulf H. and Bollschweiler, Elfriede (2013). pT2 Adenocarcinoma of the Esophagus: Early or Advanced Cancer? Ann. Thorac. Surg., 96 (5). S. 1840 - 1846. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1552-6259

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Abstract

Background. There is an increasing trend to include patients with esophageal carcinoma invading the muscularis propria (pT2) in neoadjuvant therapy regimens. But it is unclear which patients have prognostic benefit from this strategy. The aim of this study was to assess the prognosis and prognostic factors in patients with pT2 esophageal adenocarcinoma to further optimize treatment strategies. Methods. Included were patients with pT2 esophageal adenocarcinoma treated operatively at three centers specializing in upper gastrointestinal surgery. There were 159 patients (139 male) without induction therapy; median age was 64.5 years. Survival was analyzed by univariate and multivariate analysis. Results. In 37% of patients (n = 59), no lymph node involvement (pN0) was detected. Overall 5-year survival rate for all patients was 37%; for pN0 patients it was 62%, and for patients with lymph node metastases (pN+) it was 24%. Median number of examined lymph nodes was 26. Extracapsular lymph node involvement (ELNI) was evident in 55 of 100 pN+ patients with a 5-year survival rate of 14%. Patients without ELNI had a 5-year survival rate of 36% (p = 0.041). Results were comparable in all participating hospitals. Thirty-day and 90-day mortality rates of the entire collective were 2.6% and 3.8%, respectively. Multivariate analysis of prognosis revealed the lymph node ratio (p < 0.001) and the pN-ELNI category (p = 0.005) as significant parameters (pN0 hazard ratio 1 [reference]; pN+ without ELNI hazard ratio 2.2, 95% confidence interval: 1.2 to 3.8); pN+ with ELNI hazard ratio 2.5, 95% confidence interval: 1.5 to 4.5). Conclusions. The prognosis of patients with esophageal adenocarcinoma invading the muscularis propria without lymph node metastasis is very good. However, in this study, about 30% had extracapsular lymph node involvement, which reflects particularly aggressive biological tumor behavior. (C) 2013 by The Society of Thoracic Surgeons

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Metzger, Ralf UNSPECIFIED UNSPECIFIED UNSPECIFIED Lorenz, Dietmar UNSPECIFIED UNSPECIFIED UNSPECIFIED Gockel, Ines UNSPECIFIED UNSPECIFIED UNSPECIFIED Origer, Judith UNSPECIFIED UNSPECIFIED UNSPECIFIED Plum, Patrick S. UNSPECIFIED orcid.org/0000-0002-8165-4553 UNSPECIFIED Junginger, Theodor UNSPECIFIED UNSPECIFIED UNSPECIFIED Drebber, Uta UNSPECIFIED UNSPECIFIED UNSPECIFIED Hansen, Torsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Kruempelmann, Kristina UNSPECIFIED UNSPECIFIED UNSPECIFIED Fisseler-Eckhoff, Annette UNSPECIFIED UNSPECIFIED UNSPECIFIED Lang, Hauke UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoelscher, Arnulf H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bollschweiler, Elfriede UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-472804
DOI:	10.1016/j.athoracsur.2013.05.086
Journal or Publication Title:	Ann. Thorac. Surg.
Volume:	96
Number:	5
Page Range:	S. 1840 - 1846
Date:	2013
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1552-6259
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LYMPH-NODE INVOLVEMENT; INDEPENDENT PROGNOSTIC-FACTORS; EXTRACAPSULAR EXTENSION; GASTROESOPHAGEAL JUNCTION; SURGICAL RESECTION; POSITIVE PATIENTS; GASTRIC-CANCER; CARCINOMA; METASTASIS; SURVIVAL Multiple languages Cardiac & Cardiovascular Systems; Respiratory System; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/47280