AI Article Synopsis
- Lymphovascular invasion (LVI) significantly affects the postoperative prognosis in patients with esophageal squamous cell carcinoma (ESCC) who have undergone neoadjuvant chemotherapy (NAC) and surgery, with separate analysis of lymphatic and venous invasion being infrequently studied.
- A study involving 427 ESCC patients found that those with venous invasion alone had notably worse survival rates and higher recurrence risks, and those with both lymphatic and venous invasion faced the most severe outcomes.
- The findings suggest that identifying patients with LVI, particularly those with both types of invasion, could lead to better-targeted postoperative treatments to improve their prognosis and manage the risk of distant metastases.
Article Abstract
Background: Lymphovascular invasion (LVI) is reported to correlate with postoperative prognosis in esophageal squamous cell carcinoma (ESCC). However, reports analyzing lymphatic and venous invasion separately are rare, and no studies have examined the correlation in resected specimens after neoadjuvant chemotherapy (NAC). This study evaluated the postoperative prognosis and distant metastatic recurrence patterns in ESCC patients who underwent esophagectomy after NAC.
Methods: This retrospective study analyzed 427 ESCC patients who underwent radical esophagectomy after NAC. The study examined the association of LVI patterns with postoperative overall survival (OS), recurrence-free survival (RFS), and distant metastasis-free survival (DMFS). The study also evaluated the correlation with postoperative distant metastasis patterns.
Results: Multivariate analyses showed that patients with venous invasion (VI) alone had significantly worse OS (HR, 2.99; p < 0.001), RFS (HR, 2.92; p < 0.001), and DMFS (HR, 3.63; p < 0.001) than patients without LVI. Patients with both lymphatic invasion (LI) and VI had the worst OS (HR, 4.23; p < 0.001), RFS (HR, 3.38; p < 0.001), and DMFS (HR, 4.59; p < 0.001) among all groups. For the ypN0 patients, VI positivity was the only independent risk factor for DMFS (HR, 5.33; p < 0.001). Regarding distant organ metastasis, liver, brain, and bone metastasis were more frequently detected in patients with both LI and VI than in patients with other LVI patterns.
Conclusions: The study showed that ESCC patients treated with NAC who have resected specimens positive for VI, especially those also with positive lymphatic invasion, have a worse postoperative prognosis and a higher risk for postoperative distant metastases than those without LVI. More aggressive postoperative adjuvant therapy may be suitable for improving the prognosis of such patients.
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| http://dx.doi.org/10.1245/s10434-024-16522-z | DOI Listing |
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