Risk of lymph node metastases in patients with T1b oesophageal adenocarcinoma: A retrospective single centre experience

Table 1 Patient demographics

Patients
Total, n	60 (100%)
Average age at EMR (IQR)	70 (66-75)
Gender
Male	51 (85%)
Female	9 (15%)
Barrett's oesophagus
Circumference (range)	5 (0-13)
Maximum (range)	7 (1-15)
In surveillance program
Yes, median years (IQR)	36 (61%), 6 (3-9)
No, new finding	19 (32%)
Data N/A	5 (7%)

EMR: Endoscopic mucosal resection; IQR: Interquartile range; N/A: Not available.

Table 2 Tumour index endoscopic mucosal resection characteristics n (%)

Tumour location
Oesophagus	55 (92)
Cardia (Siewert 2)	5 (8)
Tumour histopathology
Differentiation
Well (G1)	2 (3)
Moderate (G2)	28 (47)
Poor (G3)	29 (49)
X (GX)	1 (1)
Depth of submucosal invasion
Sm1 (< 500 μm)	25 (42)
Sm2/3 (> 500 μm)	25 (42)
X	10 (16)
Lymphovascular invasion
Negative (LVI-)	40 (67)
Positive (LVI+)	14 (23)
X (LVX)	6 (10)
Resection (vertical margin)
Complete (R0)	17 (28)
Incomplete (R1)	43 (84)
Tumour risk group
Low-risk (LR)	13 (22)
High-risk (HR)	47 (78)

EMR: Endoscopic mucosal resection; IQR: Interquartile range; X: Indefinite.

Table 3 Histopathologic tumour characteristics of all patients with T1b oesophageal adenocarcinoma on endoscopic mucosal resection who underwent surgery - comparison of endoscopic and surgical resection specimens’ pathology report

Case	Endoscopic resection specimen	Surgical resection specimen	Note
1	Sm1, G3, LVI-, R1	T1a, LVI-, R0	/
2	Sm1, G3, LVI-, R1	T1b Sm1, G3, R0	/
3	SmX, G2, LVI-, R1	T1b, G3, LVI-, R0	/
4	Sm2/3, G3, LVI-, R1	No residual cancer	LGD in surgical margin
5	Sm1, G2, LVI-, R1	No residual cancer	HGD in surgical margin
6	Sm1, G3, LVI-, R1	T1b, G2, R0	/
7	Sm2/3, G3, LVI+, R1	T1a, G3, R0	Positive for LNM (2/16)
8	Sm2/3, G2, LVI-, R1	No residual cancer	LGD in surgical margin
9	Sm2/3, G3, LVI-, R1	No residual cancer	/
10	Sm2/3, G3, LVI-, R1	T1a, G3, LVI+, R0	/
11	Sm2/3, G3, LVIX, R1	T1b, G2, R0	Positive for LNM (3/12)
12	Sm2/3, G3, LVI+, R1	T2, G3, R1	R1, negative for LNM (16), preop EUS T1b
13	Sm2/3, G2, LVI+, R1	No residual cancer	/
14	Sm1, G3, LVI+, R1	T1b, G1, LVI-, R0	/
15	SmX, G3, LVI+, R1	T1b, G3, R0	Positive for LNM (1/23)
16	Sm2/3, G3, LVI+, R1	No residual cancer	/
17	Sm1, G3, LVIX, R1	T2, R0	Preop EUS T1 stage
18	SmX, G3, LVI+, R1	T3, G3, R0	Positive for LNM (3/78), preop EUS T1b
19	Sm2/3, G3, LVI-, R1	T1a, G3, R0	/
20	Sm2/3, G2, LVI-, R1	T1, R0	/
21	SmX, G3, LVI-, R1	No residual cancer	/
22	Sm1, G2, LVI-, R0	No residual cancer	LR tumour, HGD in surgical margin

Sm1: Submucosal invasion < 500 μm; Sm2/3: Submucosal invasion > 500 μm; G1: Well differentiated tumour; G2: Moderately differentiated tumour; G3: Poorly differentiated tumour; LVI: Lymphovascular invasion; R0: Complete resection; R1: Incomplete resection; X: Indefinite; LNM: Lymph node metastases; LGD: Low grade dysplasia; HGD: High grade dysplasia; LR: Low-risk tumour; HR: High-risk tumour.

Table 4 Overview of patients with metastatic T1b OAC

Case	EMR tumour histopathology	Treatment after index EMR	Time till metastases (mo)1	Additional treatment	End study outcome	Cause of death	Survival2 (mo)
1	Sm2/3, G3, LVIX, R1	Surgery	4	Chemotherapy	Deceased	OAC	45
2	SmX, G3, LVI+, R1	Surgery	2	None	Alive	/	87
3	SmX, G3, LVI+, R1	Surgery	4	CRT	Deceased	OAC	8
4	Sm2/3, G3, LVI+, R1	Surgery	2	Chemotherapy	Alive	/	55
5	Sm2/3, G3, LVIX, R1	Conservative	38	CRT	Deceased	OAC	40
6	Sm2/3, G2, LVI+, R1	Conservative	4	CRT	Deceased	OAC	9
7	Sm2/3, G2, LVI-, R1	Conservative	3	CRT	Deceased	OAC	31
8	Sm2/3, G2, LVI+, R1	Conservative	4	CRT	Deceased	OAC	18
9	Sm1, G2, LVI-, R1	Conservative	17	EMR T1a, CRT	Alive	/	26
10	Sm2/3, G3, LVI-, R1	Conservative	13	Radiotherapy	Deceased	OAC	30

¹Time from index EMR until LNM/metastatic disease;

²Time from index EMR until the end of the study or death of the patient. EMR: Endoscopic mucosal resection; LNM: Lymph node metastases; Sm1: Submucosal invasion < 500 μm; Sm2/3: Submucosal invasion > 500 μm; G2: Moderately differentiated tumour; G3: Poorly differentiated tumour; LVI: Lymphovascular invasion; R0: Complete resection; R1: Incomplete resection; X: Indefinite; CRT: Chemoradiation therapy; OAC: Oesophageal adenocarcinoma; N/A: Not available.