SURGICAL PATHOLOGY OF ADENOCARCINOMA ARISING IN BARRETTS-ESOPHAGUS - ANALYSIS OF 67 CASES

Numerous reviews of adenocarcinoma arising in Barrett's esophagus have been reported, but detailed pathologic findings or survival analysis have rarely been provided. This retrospective study analyzed 67 patien ts (mean age, 64 years; male-to-female ratio, 10:1) with an adenocarci noma arising in Barrett's esophagus treated by surgical resection. Pre valence of smokers was 63%, alcohol users, 45%, and patients with hiat al hernia, 73%. Five patients had another synchronous cancer, and seve n patients, previous esophageal surgery. Forty percent of the tumors w ere well differentiated, 31% moderately differentiated, 15% poorly dif ferentiated, 7% mucinous, and 6% composed of signet-ring cells. Depth of invasion in the esophageal wall was limited to mucosa in 13% of cas es and submucosa in 18%. Invasive adenocarcinomas extended to the musc ular layer in 12% of cases, to adventitia in 33%, and to periesophagea l tissue in 24%. Vascular and perineural neoplastic invasion was prese nt in 67 and 38% of cases. Regional lymph node involvement and distant metastases were found in 51 and 9% of cases. Overall, 1-, 2-, and 5-y ear survival rates were 63, 41, and 32%, respectively. Five-year survi val rate was significantly better for patients with superficial cancer limited to mucosa or submucosa (82 vs. 12%) or without regional lymph node involvement (59 vs. 10%). Tumor differentiation, vascular and pe rineural invasion, extranodal spread, distant metastases, and resectio n margins status also had a significant prognostic value on univariate analysis. In a multivariate Cox regression analysis for overall survi val, depth of invasion in the esophageal wall and regional lymph node involvement were independent prognostic factors. Careful pathologic st aging is of value in determining the prognosis of patients with adenoc arcinoma arising in Barrett's esophagus.