Mucosal Versus Submucosal Lymphovascular Invasion in Early Esophageal Cancer

Area of Science:

• Oncology
• Pathology
• Surgical Oncology

Background:

• Lymphovascular invasion (LVI) in early esophageal adenocarcinoma (EAC) can be categorized by depth (mucosal or submucosal) and focality (unifocal or multifocal).
• These specific pathological features of LVI are not consistently reported, limiting their clinical utility.
• Understanding LVI characteristics is crucial for predicting outcomes in resected EAC.

Purpose of the Study:

• To evaluate the prognostic impact of LVI depth and focality on disease-free survival (DFS) and overall survival (OS) in patients with resected pT1 EAC.
• To determine if detailed pathological assessment of LVI improves risk stratification.
• To highlight the need for standardized reporting of LVI characteristics.

Main Methods:

• Retrospective review of 38 patients with resected pT1 EAC and LVI, compared to 196 LVI-negative controls.
• Classification of LVI based on deepest depth (mucosal vs. submucosal) and number of foci (unifocal, 2-3 foci, >3 foci).
• Kaplan-Meier survival analyses to compare DFS and OS between LVI subgroups.

Main Results:

• Submucosal LVI (smLVI) was associated with significantly worse DFS compared to mucosal LVI (mLVI) or no LVI (p=0.024).
• Patients with deeper and/or multifocal LVI demonstrated significantly lower DFS (p=0.045) and OS (p<0.01) compared to those with unifocal LVI.
• mLVI did not show a significant difference in DFS compared to LVI-negative patients (p=0.303).

Conclusions:

• LVI depth and focality are significant prognostic indicators in pT1 EAC.
• These pathological features, particularly smLVI and multifocal LVI, should be further investigated as biomarkers.
• Standardized reporting of LVI characteristics in pathology reports is warranted for improved patient management.