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Original research
“Find Your Y”: histological differences in early stage (pT) and post-treatment (ypT) oesophageal adenocarcinoma with implications for salvage endoscopic resection
  1. Richard R Pacheco1,
  2. Goo Lee2,
  3. Zhaohai Yang3,
  4. Jingmei Lin4,
  5. Deepa T Patil5,
  6. Mariam Youssef2,
  7. Qingzhao Zhang3,
  8. Ahmad Mahmoud Alkashash4,
  9. Jingwei Li5,
  10. Hwajeong Lee1
  1. 1Pathology and Laboratory Medicine, Albany Medical Center, Albany, New York, USA
  2. 2Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  3. 3Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  4. 4Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana, USA
  5. 5Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Hwajeong Lee, Pathology, Albany Medical Center, Albany, NY 12208, USA; LeeH5{at}mail.amc.edu

Abstract

Aims Current guidelines offer limited strategies for managing recurrent/persistent oesophageal adenocarcinoma (EAC). Salvage endoscopic mucosal/submucosal resection (ER) shows promise in oesophageal squamous cell carcinoma, however its success in EAC is limited. We aimed to elucidate histological characteristics influencing salvage ER success in patients with low-stage, pretreated EAC.

Methods We retrospectively reviewed 272 EAC tumours postoesophagectomy from five US centres and collected clinicopathological data including discontinuous growth (DG), defined as separate tumour foci ≥2 mm from the main tumour. We selected 101 patients with low-stage disease and divided them into treatment-naïve (n=70) and neoadjuvant therapy (n=31) groups. We compared the two groups and differences in clinical, histological and outcome characteristics were identified.

Results In the entire cohort (n=272), DGs were identified in 22% of cases. Multivariate analysis revealed DGs as an independent prognostic factor for recurrence and positive oesophagectomy margins. Lymphovascular invasion (LVI) and background intestinal metaplasia predicted DG presence and absence, respectively. Compared with the treatment-naïve low T-stage subgroup, the pretreated subgroup exhibited higher incidence of poorly differentiated carcinoma (16% vs 46%, p=0.007), larger tumours (14 vs 30 mm, p<0.001), higher tumour, node, metastases stage (7% vs 30%, p=0.004), more nodal disease (7% vs 36%, p<0.001) and frequent DGs (1% vs 13%, p=0.030).

Conclusions In treated low T-stage EACs, DGs may contribute to suboptimal outcomes following salvage ER. Presence of LVI (as a surrogate for DGs) and poor differentiation in the absence of intestinal metaplasia in biopsy samples may serve as histological poor prognosticators in treated patients with EAC being considered for salvage ER.

  • gastrointestinal neoplasms
  • esophagus
  • neoplasms

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/jcp-2024-209688

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Handling editor Runjan Chetty.

    • X @HwajeongL

    • Contributors Concept and design: RRP, HL. Data collection: RRP, GL, ZY, JLin, DTP, MY, QZ, AA, JLi, HL. Data Analysis and Interpretation: RRP, GL, ZY, JLin, DTP, MY, QZ, AA, JLi, HL. Manuscript drafting and revision: RRP, GL, ZY, JLin, DTP, MY, QZ, AA, JLi, HL. Statistical analysis: RRP, HL. All authors have reviewed and approved the final version of the manuscript. HL is responsible for the overall content as guarantor. The guarantor accepts full responsibility for the finished work and/or the conduct of the study, had access to the data and controlled the decision to publish. During the preparation of this work, the authors used ChatGPT (OpenAI’s ChatGPT, GPT-4 Architecture, January 2024 version, https://chat.openai.com/chathttps://chat) in order to improve readability and structure. This tool did not replace key authoring tasks such as producing scientific, pedagogic or medical insights, drawing scientific conclusions or providing clinical recommendations. After using this tool/service, the authors meticulously reviewed and edited the content as needed and take full responsibility for the content of the publication.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests One of the coauthors (DTP) is an editor for Journal of Clinical Pathology.

    • Provenance and peer review Not commissioned; externally peer reviewed.