Abstract
Background
We have reported that lymph node metastasis risk in cases of superficial Barrett's esophageal cancer (BC) was of submucosal invasion within 500μm without other risk factors (lymphovascular involvement, a poorly differentiated component, and lesion size) through a multicenter retrospective study in 13 facilities. Cardiac cancer (CC) was included in the gastric cancer criteria of the Japanese Gastric Cancer Association. Since BC and CC near the esophagogastric junction (EGJ) show almost the same biological behavior, we elucidated the metastasis risk factors in patients with EGJ adenocarcinoma.
Methods
Patients who underwent ESD for superficial EGJ adenocarcinoma as Siewert typeII between January 2011 and April 2017 were included.
Results
A total of 120 patients were analyzed. Fifty-three patients (44.1%) had BC and 67 patients (55.8%) had CC. Of the 120 lesions, the median size was 16.7 ± 8.5 mm; 10 (8.3%; 4 BC, 6 CC) were greater than 30 mm in size. Thirty-five (29.1%; 17 BC, 18 CC) were submucosal (SM) cancers. Twenty-one (17.5%; 13 BC, 8 CC) had poorly differentiated components and 19 (15.8%; 14 BC, 5 CC) had lymphovascular involvement. Of the 19 cases with lymphovascular involvement, 11/22 (50%) were SM cancers with > 200μm of invasion, and 8/98 (8.1%) were mucosal (M)/SM cancers within SM200μm of invasion. Of the BCs with DMM invasion, 7/17 (41.1%) had lymphovascular involvement. Of the patients initially treated through ESD, 33 (27.5%) had lymphovascular involvement, positive horizontal/vertical margins, or SM > 200μm of invasion. Of these, 26 were treated with additional surgery. Metastasis was confirmed from 2 patients. Both were BCs, with SM > 501μm of invasion, positive lymphovascular involvement, and with poorly differentiated components. One was > 30 mm in size. Metastasis was not identified in CC and in cases with SM < 200μm of invasion.
Conclusion
For superficial esophagogastric cancer, we did not identify metastasis in patients with SM > 501 μm of invasion. There were no cases of metastasis in patients without risk factors. ESD might be indicated for lesions within SM 500μm of invasion without risk factors. Among DMM cases of BC, lymphovascular involvement was highly frequent. Therefore, histopathological surveillance for lymphovascular involvement is important.
Disclosure
All authors have declared no conflicts of interest.
A Risk Prediction Model Based on Lymph-Node Metastasis in Poorly Differentiated–Type Intramucosal Gastric Cancer
