ESOPHAGEAL SQUAMOUS-CELL CARCINOMA - PATHOLOGY AND PROGNOSIS

Between 1985 and 1992 a total of 403 patients with resected thoracic e sophageal squamous cell carcinoma were evaluated histopathologically, and various pathologic findings related to survival were examined. Con cerning depth of tumor invasion, 8 (2%) cases were pTis, 110 (27%) wer e pT1, 48 (12%) were pT2, 202 (50%) were pT3, and 35 (9%) were pT4. Ly mphatic invasion was detected in 299 cases (74%), blood vessel invasio n in 200 cases (49%), intramural metastasis in 45 (11%), and lymph nod e metastasis in 232 (58%). In pT1 carcinoma cases, 4% of mucosal carci nomas and 30% of submucosal carcinomas had lymph node metastasis. Tumo rs with deeper invasion had a higher incidence of lymph node metastasi s: 74% of pT3 carcinomas and 83% of pT4 carcinomas. The sites of lymph node metastasis were divided into mediastinal, cervical, and abdomina l fields; and rates of lymph node metastasis were 49%, 14%, and 41%, r espectively. In all resected cases, the operative mortality rate was 3 .2%, and the overall 5-year survival rate was 44.8%. The 5 year surviv al rate of patients with curative resection (R(0) and R(1)) was 49.5%, whereas patients with palliative resection (R(2)) did not survive mor e than 3 gears. There was no significant difference in survival relati ve to tumor location. In curatively resected cases, the significant pr ognostic factors by multivariate analysis were pT category, vascular i nvasion, lymph node metastasis, and intramural metastasis. Prognosis o f lymph node-positive cases did not depend on the positive node site. Patients with only one positive node had a better prognosis, and those with six or more positive nodes had a poor prognosis. Concerning lymp h node metastasis, other factors that worsened prognosis were a positi ve node larger than 1 cm, two- to three field metastasis, and positive cervical nodes in cases of lower-third esophageal carcinoma.