SSAT - Prognostic Factors of Very Long-Term Survival and Causes of Death in Early Esophageal Adenocarcinoma

Prognostic Factors of Very Long-Term Survival and Causes of Death in Early Esophageal Adenocarcinoma
Juha T. Kauppi¹, Ines Gockel², Tuomo Rantanen¹, Torsten Hansen³, Ari RistimäKi⁴, Hauke Lang², Theodor Junginger², Jarmo a. Salo^*¹
¹Division of General Thoracic and Esophageal Surgery, Dept of Cardiothoracic Surgery, Helsinki University Central Hospital, Helsinki, Finland; ²Dept of General and abdominal Surgery, University Medical Center, Mainz, Germany; ³Institute of Pathology, University Medical Center, Mainz, Germany; ⁴Dept of Pathology, HUSLAB, Helsinki University Central Hospital and Haartman Institute and Genome-Scale Biology Research Program, University of Helsinki, Helsinki, Finland

Patients and Methods: 85 patients (p) (36 women and 49 men, median age 72, range 40-94) without neoadjuvant treatment were operated on because of EEAC (pT1N0-1, M0) between 1984-2011. Autopsy records and death certificates were acquired. Medical and pathology reports were reviewed and 75 (88%) specimens could be reanalyzed for cancer penetration by two experienced pathologists (HT and RA). Survival was calculated according to Kaplan-Meier and the Cox regression proportional hazards model. 39 p had transhiatal, 36 transthoracic en-bloc, 5 vagal-sparing esophageal resection and, 5 solely endoscopic mucosal resection.
Results: Cancer penetration: pT1a in 33 p and pT1b in 42 p. Overall survival probability: 67.7% at 5, 49.2% at 10, 41% at 20 years. Disease specific survival: 78.3% at 5, 72.3% at 10 years. Lymph-node metastasis: (HR 7.9 [95%CI 2.53-24.78] p<0.0001 and Sm2-3 infiltration (HR 4.85 [95%CI 1.36-17.3] p=0.015) showed worse prognosis. Cumulative mortality: 33/85 (38.8%). Cause of death: esophageal adenocarcinoma (EAC) 13 (39.4%), secondary malignancy 5 (15.2%), cardiovascular 3 (9.1%), miscellaneous 9 (27.2%). Lowest number of EEAC-deaths in patients with infiltration depth pT1a and pT1b (Sm1): 4 p (12.1%).

Conclusion: Patients with intramucosal and superficial submucosal (Sm1) cancer infiltration die mostly not of EEAC. Less invasive therapy may be sufficient in this group. For patients with deeper cancer infiltration (Sm2-Sm3) more radical treatment options should be considered.

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