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Invasion depth impacts metastasis, mortality risk in esophageal carcinoma after resection
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Risks for death and metastasis after resection increased according to the depth of cancer infiltration among patients with squamous cell carcinoma in a recent study.
Researchers evaluated 402 patients who underwent endoscopic resection (ER) for squamous cell carcinoma, including 280 cases of epithelial (EP) or lamina propria (LPM) cancer, 70 of muscularis mucosa (MM) cancer and 52 of submucosal (SM) cancer. Patients with SM cancer were further divided according to depth of invasion into the submucosa: 0.2 mm or less (SM1) or more than 0.2 mm (SM2). Follow-up lasted until either death or conclusion of the follow-up program in April 2011 in 98.2% of cases (mean duration, 50 months).
Forty-nine patients died, and 15 developed lymph node or distant metastasis during the study. Survival at 5 years varied widely, with rates of 90.5% for patients with EP or LPM, 71.1% for MM and 70.8% for SM cancer (P=.007). Incidence of metastasis at 5 years also was different, with cumulative rates of 36.2% among those with SM2 cancer, 7.7% for SM1, 8.7% for MM and 0.4% for EP or LPM cancer (P<.001). For mucosal cancer patients with lymphovascular involvement, 5-year metastasis rates were greater (46.7% of cases vs. 0.7% in those without; P<.0001).
Multivariate analysis indicated that age (HR=1.07, 1.03-1.11 per year) and depth of mucosal invasion (HR=3.6, 1.6-7.8 for MM; HR=3.2, 1.1-9.0 for SM cancer vs. EP or LPM cancer) were independently predictive of survival. Invasion depth also was predictive of metastasis risk (HR=13.1, 1.3-133.7 for MM; HR=40.2, 2.9-552.7 for SM1 and HR=196.3, 10.9-3,523.6 for SM2 cancer vs. EP or LPM cancer) (95% CI for all).
“This is the first study to report the cumulative metastasis rates in these groups, and is the largest study to date describing long-term survival after ER of esophageal carcinoma,” the researchers wrote. “Long-term outcomes after ER of esophageal squamous cell carcinoma indicate that the metastasis rate is mainly associated with the depth of invasion. These rates or even higher potential rates of recurrence should be taken into account when considering the indications for ER.”
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