Esophageal squamous cell carcinoma: Pathology and prognosis

Between 1985 and 1992 a total of 403 patients with resected thoracic esophageal squamous cell carcinoma were evaluated histopathologically, and various pathologic findings related to survival were examined. Concerning depth of tumor invasion, 8 (2%) cases were pTis, 110 (27%) were pT1, 48 (12%) were pT2, 202 (50%) were pT3, and 35 (9%) were pT4. Lymphatic invasion was detected in 299 cases (74%), blood vessel invasion in 200 cases (49%), intramural metastasis in 45 (11%), and lymph node metastasis in 232 (58%). In pT1 carcinoma cases, 4% of mucosal carcinomas and 30% of submucosal carcinomas had lymph node metastasis. Tumors with deeper invasion had a higher incidence of lymph node metastasis: 74% of pT3 carcinomas and 83% of pT4 carcinomas. The sites of lymph node metastasis were divided into mediastinal, cervical, and abdominal fields; and rates of lymph node metastasis were 49%, 14%, and 41%, respectively. In all resected cases, the operative mortality rate was 3.2%, and the overall 5‐year survival rate was 44.8%. The 5‐year survival rate of patients with curative resection (R0 and R1) was 49.5%, whereas patients with palliative resection (R2) did not survive more than 3 years. There was no significant difference in survival relative to tumor location. In curatively resected cases, the significant prognostic factors by multivariate analysis were pT category, vascular invasion, lymph node metastasis, and intramural metastasis. Prognosis of lymph node‐positive cases did not depend on the positive node site. Patients with only one positive node had a better prognosis, and those with six or more positive nodes had a poor prognosis. Concerning lymph node metastasis, other factors that worsened prognosis were a positive node larger than 1 cm, two‐ to three‐field metastasis, and positive cervical nodes in cases of lower‐third esophageal carcinoma. Résumé Entre 1985 et 1992, 403 patients ayant eu une résection de leur cancer épidermoïde de l'oesophage thoracique ont eu une évaluation histopathologique corrélée avec la survie. En ce qui concerne la profondeur de l'invasion, huit cas (2%) étaient des pTis, 110 (38%) étaient des pT1, 48 (12%) étaient des pT2, 202 (50%) étaient des pT3, et 35 (8%) étaient des pT4. L'atteinte lymphatique a été détectée chez 299 (74%) patients, une invasion vasculaire dans 200 (49%) des cas, une résurgence intramurale dans 45 (11%) des cas et une atteìnte ganglionnaire chez 232 (58%) des cas. Dans le cas des tumeurs pT1, 4% des cance