Primary Motility  Disorders of the  Esophagus
 The Esophageal
 Mucosa
 The
 Esophagogastric  Junction
 Barrett's
 Esophagus

  Browse by Author
  Browse by Movies
OESO©2015
 
Volume: The Esophagogastric Junction
Chapter: Esophageal columnar metaplasia (Barrett s esophagus)
 

What is the risk of nodal metastasis from superficial adenocarcinoma arising in Barrett's esophagus?

R.C. Haggitt (Seattle)

Superficial adenocarcinoma arising in Barrett's esophagus is defined herein as adenocarcinoma with invasion limited to the mucosa (intramucosal carcinoma) or to the mucosa and submucosa (submucosal carcinoma). Determining the risk of nodal metastasis when carcinoma is limited to the mucosa or mucosa and submucosa serves as an important surrogate marker for prognosis because it is well established that nodal metastasis is one of the most important independent prognostic indicators. Relatively few studies have been published in which the data are presented in a manner that allows determination of the prevalence of nodal metastasis with carcinoma limited to the mucosa and submucosa.

Table I summarizes data published in five different papers in which it was possible to determine the number of cases of intramucosal and submucosal carcinoma, respectively, with positive nodes. Note that none of 40 patients with intramucosal carcinoma alone had positive lymph nodes. Three of the patients with submucosal carcinoma had positive nodes, and one had distant metastasis at the time of the surgical resection; however, this patient had a poorly differentiated tumor with lymphatic invasion [5]. Thus, if one summarizes all cases of superficial adenocarcinoma in Barrett's esophagus, i.e. intra- and submucosal carcinomas, 4 of 67 (6%) had either positive lymph nodes or distant metastasis at the time of surgical resection.
Table I. Prevalence of nodal metastasis in super

Insufficient data exist to determine if the patients with invasion limited to the submucosa, but who had positive nodes or distant metastasis at the time of diagnosis, had other pathologic risk factors predictive of an adverse outcome. For example, one cannot determine whether the patients with positive nodes had poorly differentiated tumors or lymphatic invasion, findings that are associated with an increased risk of an adverse outcome.

The reason so few studies provide data that permit the analysis shown in Table I is that most report survival rates for T, N and M stages or stage groupings (0-IV), which does not permit determination of the prevalence of positive lymph nodes with invasion limited to the mucosa or mucosa and submucosa.

References

1. Peters JH, Clark GWB, Ireland AP, Chandrasoma P, Smyrk TC, DeMeester TR. Outcome of adenocarcinoma arising in Barrett's esophagus in endoscopically surveyed and nonsurveyed patients. J Thorac Cardiovasc Surg 1994;108:813-822.

2. Paraf F, Fléjou JF, Pignon JP, Potet F. Surgical pathology of adenocarcinoma arising in Barrett's esophagus. Am J Surg Pathol 1995;19:183-191.

3. De Baecque C, Potet F, Molas G, Fléjou JF, Barbier P, Martignon C. Superficial adenocarcinoma of the oesophagus arising in Barrett's mucosa with dysplasia: a clinico-pathological study of 12 patients. Histopathology 1990;16:213-220.

4. DeMeester TR, Attwood SEA, Smyrk TC, Therkildsen DH, Hinder RA. Surgical therapy in Barrett's esophagus. Ann Surg 1990;212:528-540.

5. Levine DS, Haggitt RC, Blount PL, Rabinovitch PS, Rusch VW, Reid BJ. An endoscopic biopsy protocol can differentiate high-grade dysplasia from early adenocarcinoma in Barrett's esophagus. Gastroenterology 1993;105:40-50.


Publication date: May 1998 OESO©2015