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Mitsuo Tachibana, MD; Shoichi Kinugasa, MD; Dipok Kumar Dhar, MD; Hideki Tabara, MD; Reiko Masunaga, MD; Tsukasa Kotoh, MD; Hirofumi Kubota, MD; Naofumi Nagasue, MD

Arch Surg. 1999;134:50-54.

Background  Prognostic indicators in patients with T2 tumor have not been fully understood.

Objective  To clarify the clinicopathologic characteristics and long-term results 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 thoracic esophagus, 142 patients underwent esophagectomy with curative intent: 97 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 other than esophageal cancer.

Main Outcome Measures  Clinicopathologic characteristics and long-term results.

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 patients 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 with pT2 N0 tumor, and 12 patients with pT2 N[+] tumor). The sites of metastatic nodes in 6 survivors with pT1 N(+) tumor were a solitary perigastric node in 4 patients, a solitary mediastinal node in 1 patient, and 2 mediastinal nodes in 1 patient. The 5-year survival rates of patients with pT1 N0, pT1 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 Borrmann classification (0, 1 vs 2, 3, 4), tumor size (<4.0 vs 4.0 cm), combined T, N factor (pT2 N[+] vs others), time of operation (420 vs >420 minutes), estimated blood loss (<1000 vs 1000 mL), and lymph vessel invasion (marked vs not marked). Stage pT2 N(+) tumor became a single independent prognostic factor for survival as determined by multivariate analysis (pT2 N[+] vs others; P=.008).

Conclusions  Stage pT1 N(+) tumors with a few diseased nodes and pT2 N0 tumors are considered to be a group with an excellent prognosis, similar to pT1 N0 tumors. Patients with pT2 N(+) diseases had worse prognoses and thus should have meticulous lymph node dissection and extensive adjuvant therapy.

From the Second Department of Surgery, Shimane Medical University, Shimane, Japan.

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