CLINICOPATHOLOGICAL FEATURES OF SUPERFICIAL SQUAMOUS-CELL CARCINOMA OF THE ESOPHAGUS

BACKGROUND: The depth of penetration is the crucial factor determining the prognosis of esophageal carcinoma patients. Patients with superfi cial esophageal carcinoma have a significantly favorable clinical cour se compared with those with advanced cancers. The outcome for patients with mucosal cancer is excellent with a 5-year survival rate exceedin g 80%. On the other hand, submucosal cancer often metastasizes to lymp h nodes or other organs, and the prognosis of these patients is far fr om satisfactory. METHODS: Among 165 patients with squamous cell carcin oma of the esophagus, surgically resected between December 1979 and Ap ril 1995, 30 patients (18.2%) had superficial esophageal carcinoma (SE C) confined to the epithelium, lamina propria mucosa, or submucosa. Di sease profile and clinicopathological characteristics of these 30 pati ents were studied. RESULTS: The incidence of SEC has increased from 6. 3% (2 of 32) in the first 5-year period (1979 to 1984) to 27.4% (20 of 73) in the recent 5-year period (1991 to 1995). Subjective symptoms w ere present in 2 (13.3%) with 15 mucosal cancers and in 4 (26.7%) with 15 submucosal cancers. The remaining 24 patients (80%) had no subject ive symptoms. Twenty-two patients (73.3%) were diagnosed to have the l esions by endoscopic examination at the time of screening for gastric problems, and only 3 were detected by gastrointestinal series. None of the 15 patients with mucosal cancer had lymphatic invasion, venous in vasion, or lymph node metastasis. On the other hand, in those with sub mucosal cancers, 9 (60%) had lymphatic invasion, 5 (33.3%) venous inva sion, and 8 (53.3%) lymph node metastases. Twenty-two patients are ali ve without recurrence. The 3- and 5-year survival rates are 86.7% and 86.7% for patients with mucosal cancer and 72.2% and 65.0% for those w ith submucosal cancer, respectively. CONCLUSION: Esophagectomy with wi de lymphadenectomy should be carried out for submucosal cancer, wherea s esophagectomy with moderate lymphadenectomy can be preferred for muc osal cancer. (C) 1997 by Excerpta Medica, Inc.