Prognostic significance of tumor ploidy and histomorphological parameters in adenocarcinoma of Barrett's esophagus

Background: Despite recent advances in surgical and multidisciplinary treat ment, the prognosis for patients with adenocarcinoma of Barrett's esophagus remains poor. The low prognostic accuracy of even surgical pathologic TNM staging suggests that additonal parameters are necessary in determining the prognosis. Method: In a retrospective analysis of 50 patients who underwen t transhiatal or transthoracic esophageal resection due to adenocarcinoma o f Barrett's esophagus, a quantitative DNA analysis using image cytometry wa s performed in addition to the TNM classification and usual morphological c riteria. At the time of DNA analysis the histomorphological parameters and survival time were not known. Results: The main prognostic parameter was th e curativity (R classification) of the operation. Considering only patients after RO resection, a multivariate analysis identified the DNA ploidy, the depth of tumor infiltration and distant metastases of prognostically indep endent factors. Furthermore, within pT2 and pT3 tumors, which account for 8 0% of all the tumors, DNA ploidy allows an additional prognostic differenti ation which is not possible with pT stage alone. Conclusion: Patients with a diploid or tetraploid tumor without distant metastasis and a tumor stage pT1-pT3 should have curative (RO) resection, In case of an aneuploid DNA co ntent or a pT4 tumor resection alone shows no advantage as compared to pall iative nonoperative procedures.