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129. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

24.04. - 27.04.2012, Berlin

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Prognostic Impact of Perineural, Blood and Lymph Vessel Invasion for Esophageal Cancer Patients

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  • Michael Tachezy - Universitätsklinikum Hemburg-Eppendorf, Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
  • Florian Gebauer - Universitätsklinikum Hemburg-Eppendorf, Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
  • Asad Kutup - Universitätsklinikum Hemburg-Eppendorf, Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
  • Jakob R. Izbicki - Universitätsklinikum Hemburg-Eppendorf, Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
  • Yogesh Kumar Vashist - Universitätsklinikum Hemburg-Eppendorf, Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg

Deutsche Gesellschaft für Chirurgie. 129. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 24.-27.04.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgch285

doi: 10.3205/12dgch285, urn:nbn:de:0183-12dgch2856

Published: April 23, 2012

© 2012 Tachezy et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Introduction: Esophageal cancer is one of the most aggressive tumor types and associated with a poor prognosis of the patients. Only few studies with inconsistent results have investigated the prognostic impact of tumor-micro-invasion in blood (AI) and lymphatic vessels (LVI) and perineural invasion (PNI).

Materials and methods: Data from 644 patients, who underwent subtotal esophagectomy at University Medical Center Hamburg-Eppendorf between May 1992 and July 2009, were collected. Status of AI, LVI and PNI was determined by experienced pathologists and data were correlated with clinical and histopathological information and survival of the patients (Chi-square-test, Kaplan-Meier analysis, log-rank test). In addition, multivariate analysis was performed (Cox-regression).

Results: Twelve percent of all specimen showed an AI (n=87), 32% a LVI (n=209) and 6% only a PNI (n=36). All three factors are significantly associated with tumor size (pT), nodal involvement (pN), metastatic disease (M), grading (G) and involvement of resection margin (R). Lymphatic vessel invasion and PNI were significantly more often in adenocarcinoma (EAC) compared to squamous cell carcinoma (ESCC). Angioinvasion and LVI are associated with positive bone marrow micrometastasis status. Kaplan-Meier survival analysis revealed a prognostic impact for AI and LVI in EAC and ESCC, while PNI revealed to be a significant factor in EAC only (Table 1 [Tab. 1], Figure 1 [Fig. 1]).

Multivariate analysis showed that only LVI is an independent prognosticator for overall survival in EAC (HR 1.427, 95%CI 1.009/2.017; p=0.044). Neither LVI, nor AI and PNI revealed to be significant independent prognosticators in multivariate analysis of ESCC.

Conclusion: This retrospective study demonstrates the prognostic significance of LVI for EAC patients and supports its inclusion into the TNM staging system of the UICC. Determination of LVI might help to identify those patients who profit from adjuvant treatment after surgical resection.