Prognostic factors in T1 and T2 squamous cell carcinoma of the thoracic esophagus

Background: Prognostic indicators in patients with T2 tumor have not been f ully understood. Objective: To clarify the clinicopathologic characteristics and long-term r esults of T1 and T2 squamous cell carcinomas of the thoracic esophagus. Design: Consecutive case series. Setting: Department of surgery in a university hospital. Patients: Of 234 patients with primary squamous cell carcinoma of the thora cic esophagus, 142 patients underwent esophagectomy with curative intent: 9 7 patients had pT1 and pT2 tumors. Interventions: Investigated were clinicopathologic characteristics of 65 of 97 patients with pT1 and pT2 tumors; excluded were 7 patients who died of postoperative complications and another 25 patients who died of causes othe r than esophageal cancer. Main Outcome Measures: Clinicopathologic characteristics and long-term resu lts. Results: Pathologic tumor stages were pT1 N0 in 23 patients, pT1 N(+) in 7 patients, pT2 N0 in 15 patients, and pT2 N(+) in 20 patients. Fifty patient s are alive and free of cancer and 15 patients died of tumor recurrence (1 patient with pT1 N0 tumor, 1 patient with pT1 N[+] [+] tumor, 1 patient wit h pT2 N0 tumor, and 12 patients with pT2 N[+] tumor). The sites of metastat ic nodes in 6 survivors with pT1 N(+) tumor were a solitary perigastric nod e in 4 patients, a solitary mediastinal node in 1 patient, and 2 mediastina l nodes in 1 patient. The 5-year survival rates of patients with pT1 N0, pT 1 N(+), and pT2 N0 tumors all exceeded 85%, and the rate of those with pT2 N(+) tumor was 33.9% (pT2 N[+] vs others: pT1. N0, pT1 N[+], and pT2 N0; P= .003). The factors affecting survival rate by univariate analysis were Borr mann classification (0, 1 vs 2, 3, 4), tumor size (<4.0 vs greater than or equal to 4.0 cm), combined T, N factor (pT2 N[+] vs others), time of operat ion (less than or equal to 420 vs >420 minutes), estimated blood loss (<100 0 vs greater than or equal to 1000 mt), and lymph vessel invasion (marked v s not marked). Stage pT2 N(+) tumor became a single independent prognostic factor for survival as determined by multivariate analysis (pT2 N[+] vs oth ers; P=.008). Conclusions: Stage pT1 N(+) turners with a few diseased nodes and pT2 N0 tu mors are considered to be a group with an excellent prognosis, similar to p T1 N0 tumors. Patients with pT2 N(+) diseases had worse prognoses and thus should have meticulous lymph node dissection and extensive adjuvant therapy .