Published online Dec 26, 2016. doi: 10.13105/wjma.v4.i6.118
Peer-review started: July 18, 2016
First decision: September 7, 2016
Revised: September 13, 2016
Accepted: October 22, 2016
Article in press: October 24, 2016
Published online: December 26, 2016
Processing time: 156 Days and 2.5 Hours
To evaluate the incidence of lymph node metastasis (LNM) and its risk factors in patients with Siewert type I and type II pT1 adenocarcinomas.
We enrolled 85 patients [69 men, 16 women; median age (range), 67 (38-84) years] who had undergone esophagectomy or proximal gastrectomy for Siewert type I and type II pT1 adenocarcinomas. Predictive risk factors of LNM included age, sex, location of the tumor center, confirmed Barrett’s esophageal adenocarcinoma, tumor size, macroscopic tumor type, pathology, invasion depth, presence of ulceration, and lymphovascular invasion. Multivariate logistic regression analysis was used to identify factors predicting LNM. We also evaluated the frequencies of LNM for Siewert type I and type II pT1 adenocarcinomas in meta-data analysis.
LNMs were found in 11 out of 85 patients (12.9%, 95%CI: 5.8-20.0). Only 1 of the 15 patients (6.6%, 95%CI: 0.0-19.2) who had a final diagnosis of pT1a adenocarcinoma had a positive LNM, whereas 10 of the 70 patients (14.2%, 95%CI: 6.0-22.4) with a final diagnosis of pT1b adenocarcinoma had positive LNM. Furthermore, only one of the 30 patients (3.3%, 95%CI: 0.0-9.7) with a tumor invasion depth within 500 μm from muscularis mucosae had positive LNM. Poor differentiation and lymphovascular invasion were independently associated with a risk of LNM. In meta-data analysis, 12 of the 355 patients (3.3%, 95%CI: 1.5-5.2) who had a final diagnosis of pT1a adenocarcinoma had a positive LNM, whereas 91 of the 438 patients (20.7%, 95%CI: 16.9-24.5) with a final diagnosis of pT1b adenocarcinoma had positive LNM.
We consider endoscopic submucosal dissection (ESD) is suitable for patients with Siewert type I and type II T1a adenocarcinomas. For patients with T1b adenocarcinoma, especially invasion depth is within 500 μm from muscularis mucosae with no other risk factor for LNM, diagnostic ESD could be a treatment option according to the overall status of patients and the presence of comorbidities.
Core tip: We evaluated meta-analysis of the incidence of lymph node metastasis (LNM) in patients with Siewert type I and type II pT1 adenocarcinomas. Of previous 5 reports and our study, 12 of the 355 patients (3.38%, 95%CI: 1.5-5.2) in pT1a adenocarcinoma had LNM, whereas 91 of the 438 patients (20.7%, 95%CI: 16.9-24.5) in pT1b adenocarcinoma had LNM. We consider endoscopic submucosal dissection (ESD) to be a reasonable for patients that have well differentiated, limited to the mucosa, and within 30 mm in diameter with no lymphovascular invasion. For patients with T1b adenocarcinoma, especially invasion depth within 500 μm from muscularis mucosae with no other risk factor for LNM, diagnostic ESD could be a treatment option.