Tumor size increases the risk for lymph node metastases in T1b esophageal adenocarcinoma

Neal Mehta, Meena Sadaps, Ravi S. Shah, Sunguk Jang, John Vargo, Michael McNamara, Siva Raja, Alok Khorana, Sudish Murthy, Amit Bhatt


Background: The decision to give adjuvant therapy after endoscopic resection (ER) of T1b esophageal adenocarcinoma (EAC) in those who are not surgical candidates is largely based on a lesion’s risk of lymph node metastasis (LNM). However, risk factors for LNM in esophageal T1b EAC are not clearly defined. The aim is to evaluate risk factors for LNM in T1b EAC patients who underwent esophagectomy or ER with ≥5 years of follow-up post-procedurally.
Methods: This is a retrospective analysis completed at a large tertiary referral center. Patients who underwent esophagectomy or ER with ≥5 years follow-up, with histologically proven T1b EAC between 2010 and 2017 were included. LNM was considered positive with histologically or radiologically confirmed metastasis in esophagectomy specimens or within 5 years of follow-up post-ER.
Results: Forty patients (median age 69 years; 85% males) formed the study cohort of which 36 patients (90.0%) underwent esophagectomy and 4 patients who were not surgical candidates underwent ER. Seven (17.5%) patients developed LNM per study criteria. Tumor size was significantly (P=0.019) associated with the risk of LNM, and the optimal threshold at which tumor size as associated with metastasis was 3 cm. No other risk factors including lymphovascular invasion, differentiation on pathology, or infiltration growth pattern were associated with LNM.
Conclusions: In T1b EAC, tumor size greater than 3 cm is the variable with the most potential as a risk factor for metastasis following surgical or ER. Adjuvant therapy should be considered in patients with tumor size greater than 3 cm.