Meta-Analysis
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Dec 26, 2016; 4(6): 118-123
Published online Dec 26, 2016. doi: 10.13105/wjma.v4.i6.118
Meta-analysis of lymph node metastasis in Siewert type I and II T1 adenocarcinomas
Hiroki Osumi, Junko Fujisaki, Masami Omae, Tomoki Shimizu, Toshiyuki Yoshio, Akiyoshi Ishiyama, Toshiaki Hirasawa, Tomohiro Tsuchida, Yorimasa Yamamoto, Hiroshi Kawachi, Noriko Yamamoto, Masahiro Igarashi
Hiroki Osumi, Junko Fujisaki, Masami Omae, Tomoki Shimizu, Toshiyuki Yoshio, Akiyoshi Ishiyama, Toshiaki Hirasawa, Tomohiro Tsuchida, Yorimasa Yamamoto, Masahiro Igarashi, Departments of Gastroenterology and Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
Hiroshi Kawachi, Noriko Yamamoto, Departments of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
Author contributions: Osumi H, Fujisaki J, Omae M and Shimizu T contributed equally to this work; Osumi H collected and analyzed the data, and drafted the manuscript; Fujisaki J provided analytical oversight; Igarashi M designed and supervised the study; Fujisaki J and Kawachi H revised the manuscript for important intellectual content; Yoshio T, Ishiyama A, Hirasawa T and Tsuchida T offered the technical or material support; Yamamoto Y and Yamamoto N provided administrative support; all authors have read and approved the final version to be published.
Conflict-of-interest statement: All authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Junko Fujisaki, MD, PhD, Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan. junko.fujisaki@jfcr.or.jp
Telephone: +81-3-35200111 Fax: +81-3-35700343
Received: July 17, 2016
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
Abstract
AIM

To evaluate the incidence of lymph node metastasis (LNM) and its risk factors in patients with Siewert type I and type II pT1 adenocarcinomas.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Siewert type I and type II adenocarcinomas; Lymph node metastasis

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.