Yusuf TE et al. (2005) Clinical implications of the extent of invasion of T3 esophageal cancer by endoscopic ultrasound. J Gastroenterol Hepatol 20: 1880–1885

Stage T3 esophageal cancers encompass a range of clinical presentations, from those in which tumor invasion of the muscularis propria can only be detected by microscope, to those in which there is gross invasion beyond the muscularis propria that just stops short of invading adjacent organs. Yusuf et al. investigated whether minimally invasive disease, as assessed by preoperative endoscopic ultrasound (EUS), was associated with better patient outcome, as has been found for some other tumors. For esophageal tumors, however, this seems not to be the case.

All 39 Mayo Clinic patients selected for this retrospective study had de novo TNM STAGE T3N1M0 esophageal cancer, staged by fine-needle aspiration and CT, with EUS used to assess depth of tumor invasion. All patients subsequently underwent similar preoperative neoadjuvant chemotherapy and radiotherapy, followed by surgical esophagectomy. The median depth of tumor invasion, determined by EUS, was 3 mm: this threshold value was used to classify 17 patients as having minimally invasive and 22 as having advanced disease, respectively.

The authors found that, over the median follow-up period of 13 months, depth of tumor invasion did not predict either tumor recurrence or mortality rate. These findings support the current TNM staging system, they say, and indicate that patients with minimally invasive disease should be treated no differently from those with advanced disease. It remains to be seen, however, whether these findings can be generalized to heterogeneous patient groups.