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

SEM van de Ven; AW Gotink; FJC Ten Kate; D Nieboer; BLAM Weusten; LAA Brosens; R van Hillegersberg; LA Herrero; CA Seldenrijk; A Alkhalaf; FCP Moll; W Curvers; I van Lijnschoten; T Tang; H van der Valk; WB Nagengast; G Kats-Ugurlu; JTM Plukker; MHMG Houben; J van der Laan; RE Pouw; JJGHM Bergman; SL Meijer; MI van Berge Henegouwen; BPL Wijnhoven; PJF de Jonge; M Doukas; MJ Bruno; K Biermann; AD Koch

doi:10.1055/s-0040-1704389

Endoscopy, Inhaltsverzeichnis

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

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

Autor*innen

SEM van de Ven

¹Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
AW Gotink

¹Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
FJC Ten Kate

²Erasmus Medical Center, Pathology, Rotterdam, Netherlands
D Nieboer

³Erasmus MC University Medical Center, Public Health, Rotterdam, Netherlands
BLAM Weusten

⁴University Medical Center Utrecht, Gastroenterology and Hepatology, Utrecht, Netherlands
LAA Brosens

⁵University Medical Center Utrecht, Pathology, Utrecht, Netherlands
R van Hillegersberg

⁶University Medical Center Utrecht, Surgery, Utrecht, Netherlands
LA Herrero

⁷St. Antonius Hospital, Gastroenterology and Hepatology, Nieuwegein, Netherlands
CA Seldenrijk

⁸St Antonius Hospital, Pathology, Nieuwegein, Netherlands
A Alkhalaf

⁹Isala, Gastroenterology and Hepatology, Zwolle, Netherlands
FCP Moll

¹⁰Isala, Pathology, Zwolle, Netherlands
W Curvers

¹¹Catharina Hospital, Gastroenterology and Hepatology, Eindhoven, Netherlands
I van Lijnschoten

¹²PAMM, Pathology, Eindhoven, Netherlands
T Tang

¹³Ijselland Hospital, Gastroenterology and Hepatology, Capelle aan den Ijssel, Netherlands
H van der Valk

¹⁴Pathan, Pathology, Rotterdam, Netherlands
WB Nagengast

¹⁵University Medical Center Groningen, Gastroenterology and Hepatology, Groningen, Netherlands
G Kats-Ugurlu

¹⁶University Medical Center Groningen, Pathology, Groningen, Netherlands
JTM Plukker

¹⁷University Medical Center Groningen, Surgery, Groningen, Netherlands,
MHMG Houben

¹⁸Haga Hospital, Gastroenterology and Hepatology, Den Haag, Netherlands
J van der Laan

¹⁹Haga Hospital, Pathology, Den Haag, Netherlands
RE Pouw

²⁰Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam, Netherlands
JJGHM Bergman

²⁰Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam, Netherlands
SL Meijer

²¹Amsterdam UMC, Pathology, Amsterdam, Netherlands
MI van Berge Henegouwen

²²Amsterdam UMC, Surgery, Amsterdam, Netherlands
BPL Wijnhoven

²³Erasmus MC University Medical Center, Surgery, Rotterdam, Netherlands
PJF de Jonge

¹Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
M Doukas

²Erasmus Medical Center, Pathology, Rotterdam, Netherlands
MJ Bruno

¹Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
K Biermann

²Erasmus Medical Center, Pathology, Rotterdam, Netherlands
AD Koch

¹Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands

Abstract

Volltext

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.