Endoscopy 2020; 52(S 01): S126
DOI: 10.1055/s-0040-1704389
ESGE Days 2020 oral presentations
Saturday, April 25, 2020 11:00 – 13:00 Esophageal therapy: No limits?! Wicklow Meeting Room 3
© Georg Thieme Verlag KG Stuttgart · New York

QUANTIFICATION OF LYMPHOVASCULAR INVASION IS USEFUL TO PREDICT LYMPH NODE METASTASES IN PATIENTS WITH SUBMUCOSAL (T1B) ESOPHAGEAL ADENOCARCINOMA

SEM van de Ven
1   Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
,
AW Gotink
1   Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
,
FJC Ten Kate
2   Erasmus Medical Center, Pathology, Rotterdam, Netherlands
,
D Nieboer
3   Erasmus MC University Medical Center, Public Health, Rotterdam, Netherlands
,
BLAM Weusten
4   University Medical Center Utrecht, Gastroenterology and Hepatology, Utrecht, Netherlands
,
LAA Brosens
5   University Medical Center Utrecht, Pathology, Utrecht, Netherlands
,
R van Hillegersberg
6   University Medical Center Utrecht, Surgery, Utrecht, Netherlands
,
LA Herrero
7   St. Antonius Hospital, Gastroenterology and Hepatology, Nieuwegein, Netherlands
,
CA Seldenrijk
8   St Antonius Hospital, Pathology, Nieuwegein, Netherlands
,
A Alkhalaf
9   Isala, Gastroenterology and Hepatology, Zwolle, Netherlands
,
FCP Moll
10   Isala, Pathology, Zwolle, Netherlands
,
W Curvers
11   Catharina Hospital, Gastroenterology and Hepatology, Eindhoven, Netherlands
,
I van Lijnschoten
12   PAMM, Pathology, Eindhoven, Netherlands
,
T Tang
13   Ijselland Hospital, Gastroenterology and Hepatology, Capelle aan den Ijssel, Netherlands
,
H van der Valk
14   Pathan, Pathology, Rotterdam, Netherlands
,
WB Nagengast
15   University Medical Center Groningen, Gastroenterology and Hepatology, Groningen, Netherlands
,
G Kats-Ugurlu
16   University Medical Center Groningen, Pathology, Groningen, Netherlands
,
JTM Plukker
17   University Medical Center Groningen, Surgery, Groningen, Netherlands,
,
MHMG Houben
18   Haga Hospital, Gastroenterology and Hepatology, Den Haag, Netherlands
,
J van der Laan
19   Haga Hospital, Pathology, Den Haag, Netherlands
,
RE Pouw
20   Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam, Netherlands
,
JJGHM Bergman
20   Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam, Netherlands
,
SL Meijer
21   Amsterdam UMC, Pathology, Amsterdam, Netherlands
,
MI van Berge Henegouwen
22   Amsterdam UMC, Surgery, Amsterdam, Netherlands
,
BPL Wijnhoven
23   Erasmus MC University Medical Center, Surgery, Rotterdam, Netherlands
,
PJF de Jonge
1   Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
,
M Doukas
2   Erasmus Medical Center, Pathology, Rotterdam, Netherlands
,
MJ Bruno
1   Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
,
K Biermann
2   Erasmus Medical Center, Pathology, Rotterdam, Netherlands
,
AD Koch
1   Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

Also available at
 
 

    Aims Lymphovascular invasion (LVI) is an important prognostic factor for lymph node metastases (LNM) in patients with submucosal esophageal adenocarcinoma (T1b EAC). Currently, LVI is classified as present or absent. The aim of this study was to determine whether quantification of LVI provides additional prognostic information in patients with pT1b EAC.

    Methods Patients diagnosed with pT1b EAC between 1989-2017 and treated with surgery or endoscopic resection, were included in this nationwide multicenter retrospective cohort study. Primary endpoints were the presence of LNM in surgically resected specimens (≥12 resected lymph nodes), or the development of pathologically confirmed metastases during follow-up. All resection specimens were reassessed by three gastrointestinal pathologists. Patients were categorized into 3 groups based on the number of LVI foci: no-LVI, low-LVI (1 LVI focus), and high-LVI (≥2 LVI foci). Cox proportional hazards analysis was performed to identify risk factors for metastases.

    Results The cohort consisted of 283 patients with pT1b EAC. Median age was 66 years (IQR: 58-72), 87% was male. LVI was distributed as follows: no-LVI (n=222; 78.4%), low-LVI (n=19; 6.7%), high-LVI (n=42; 14.8%). 93 (32.9%) patients had LNM or distant metastases. The rate of metastases was higher in patients with high-LVI (78.6%), compared to patients with low-LVI (42.1%; p< 0.01) or no-LVI (23.4%; p< 0.01). The rate of metastases was not higher in patients with low-LVI (42.1%) compared to no-LVI (23.4%; p=0.07). Corrected for invasion depth and differentiation grade, the Hazard Ratios (HRs) for low-LVI and high-LVI were 1.9 (95% CI 0.9-4.1) and 3.5 (95% CI 2.2-5.6), respectively. When using LVI as a binary variable; HR was 3.0 (95% CI 1.9-4.5).

    Conclusions Patients with ≥2 LVI foci have an increased risk of developing metastases, compared to patients with only 1 LVI focus. Quantification of LVI is useful to identify pT1b EAC patients who have a high risk of developing metastases.


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