If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  UEGW: Extramural Venous Invasion, an Independent Negative Prognostic Factor for Oesophageal and Gastric Cardiac Adenocarcinomas By Chris Berrie PRAGUE, CZECH REPUBLIC -- September 29, 2004 -- The presence of extramural venous invasion is an independent negative prognostic factor for oesophageal and gastric cardiac adenocarcinomas, according to a retrospective study presented September 28th at the 12th United European Gastroenterology Week. In recent years, there has been an increase in the incidence of oesophageal and gastric cardiac adenocarcinomas in the West, with both types of cancer being characterized by poor outcomes due to the advanced stage of the disease and the presence of lymph node metastasis. However, on the basis that the outcome of these diseases may be determined by the venous invasion, Ann Driessen, MD, PhD, collaborative investigator, gastrointestinal pathologist, pathology, University Hospital Maastricht, Maastricht, The Netherlands, and colleagues designed a study to determine the prognosis of tumours located at the gastro-oesophageal junction (GOJ) in terms of the presence of extramural venous invasion and to analyse the prognostic significance of such venous invasion in relation to other prognostic markers. The researchers enrolled 191 patients with a median age of 63 years (range, 32 to 88 years; 85% males) from a single centre during a period from 1990 to 1999. These patients were being treated by primary curative surgery for an adenocarcinoma situated at the GOJ and extending into the oesophagus and the cardia. Assessment for the presence or absence of vascular invasion, as the invasion of extramural veins, was evaluated on haematoxylin–eosin-stained sections of formol-fixed, paraffin-embedded transversal sections from resection specimens (mean of 4 tumour blocks per specimen). The survival analysis used the Kaplan-Meier method and a log-rank test. The cohort comprised 71 patients with oesophageal cancers and 120 with gastric cardiac cancers; 76% had vascular invasion, while 39% had extramural venous invasion, which were independent of the localization of the tumour. The rates of vascular invasion were 79% and 73% in the oesophageal and cardia groups, respectively, and their rates of extramural venous invasion were 42% and 35%, respectively. The 10-year cumulative survival analyses were both significantly worse for the vascular invasion and the extramural venous invasion patients (P =.0003, P =.00001, respectively). In the case of the extramural venous invasion, there was also a trend according to the presence of haematogenous metastases (51% in the absence, 66% in the presence, P =.07). Following the univariate median survival analysis—tumour stage (P =.001), vascular invasion (P <.00001), extramural venous invasion (P <.00001), number of positive lymph nodes (P =.005) and extracapsular growth (P =.007)—all influenced prognosis. However, multivariate analysis revealed extramural venous invasion as the most important prognostic factor for cancer-specific death (P =.005). Other significant independent prognostic factors were positive lymph nodes (P =.002) and differentiation grade (P =.042). Extramural venous invasion also tended to correlate with a haematogenous metastatic behaviour (P =.053). Dr. Driessen stressed that vascular invasion and extramural venous invasion, in particular, is associated with a significantly poorer prognosis despite complete resection of the tumour. Therefore, pathologist reports should include the presence of extramural venous invasion, which can then be used as a selection criterion for adjuvant chemotherapy.
[Presentation title: "Extramural Venous Invasion Is an Independent Prognostic Factor in Multivariate Analysis for Oesophageal and Cardiac Adenocarcinomas. Abstract OP-G-127." Abstract 526]
|
