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Mucosal Versus Submucosal Lymphovascular Invasion in Early Esophageal Cancer
Nathaniel Deboever1, Isha Khanduri2, Michael Eisenberg1
1Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Background:
In patients with resected early-stage esophageal adenocarcinoma (EAC), presence of lymphovascular invasion (LVI) can be subdivided by deepest depth of detection (mucosal (mLVI) or submucosal (smLVI)), and as unifocal versus multifocal. We sought to evaluate these variables affect on disease-free (DFS) and overall survival (OS). These pathological LVI descriptors have not been thoroughly explored, and are not generally reported by pathologists.
Methods:
We performed a single-institution review of patients with resected pT1 EAC to characterize focality and depth of LVI (mLVI or smLVI). Kaplan-Meier analyses were performed to assess differences in DFS and OS between the groups.
Results:
The study group comprised 38 pT1 patients with LVI who were resected between 2001 and 2018. A control group of 196 pT1, LVI negative patients was used as comparison. There were 27 (71.1%) cases of mLVI and 11 (28.9%) smLVI cases. Eighteen (47.4%) exhibited a single focus of LVI, while nine (23.7%) and 11 (28.9%) patients were found to have 2-3 foci, and >3 foci of LVI, respectively. Patients with mLVI had similar DFS compared with those without LVI (p = 0.303), but those with smLVI had worse DFS (p = 0.024). Combining depth and extent of LVI showed that patients with deeper and/or a greater number of LVI foci have lower DFS (p = 0.045) and OS (p < 0.01) compared with patients with ≤1 focus of LVI.
Conclusions:
Depth and focality of LVI warrant further investigation as prognostic biomarkers in patients with pT1 EAC.
