ASO Author Reflections: Peritumoral Lymphatic Vessels as a Predictor of Response to Chemotherapy and Survival in Esophag
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Peritumoral Lymphatic Vessels as a Predictor of Response to Chemotherapy and Survival in Esophageal Cancer Tomoki Makino, MD, PhD, Takeo Hara, MD, PhD, and Yuichiro Doki, MD, PhD Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
PAST Previous studies have investigated the clinical impact of intra-tumoral lymphatic vessel density (LVD) in several types of cancer including esophageal cancer (EC). These studies have reported an induction of intra-tumoral lymphatic vessels (LVs), leading to a greater incidence of lymphovascular invasion, lymph node metastasis,1,2 and poorer prognosis.3,4 Meanwhile, because LVs maintain oncotic pressure in tissue via drainage and facilitate an immune response against tumors as a communication pathway between tumors and lymph nodes, the authors hypothesized that peritumoral LVs may play biologically more distinct roles in EC than intra-tumoral LVs.5 Because little is known about the significance of peritumoral LVs in EC, this study5 aimed to compare peritumoral LVs with non-tumoral LVs in resected specimens from EC and clarify its association with tumor characteristics and response to neoadjuvant chemotherapy (NAC). PRESENT The current study5 found that LVs were most frequent in the peritumoral lamina propria mucosa (LPM), and that the number of peritumoral LVs in the LPM was significantly lower in patients with NAC than in those without NAC. A low number of peritumoral LVs in the LPM was associated with a poorer pathologic response to NAC and greater tumor heterogeneity, in addition to worse survival for
patients undergoing NAC. In addition, multivariate analysis identified the number of peritumoral LVs in the LPM as an independent prognostic factor. To the authors’ best knowledge, the current study is the first to clarify the significance of peritumoral LVs in the LPM layer in tumor heterogeneity, response to NAC, and unfavorable survival for EC patients.5 FUTURE The current study5 indicated the possibility that NAC may reduce LV number. However, because the impact of NAC on LV number in the LPM was assessed using only resected specimens,6 further study is necessary to evaluate samples collected both before and after NAC from the same patient for a more precise comparison. Furthermore, the current study demonstrated that the low-LV group was significantly associated with a poorer pathologic response to NAC than the high-LV group, which may reflect the potential anticancer effects of peritumoral LVs in EC. Activation of the immune system through cytotoxic T lymphocytes or increased fluid drainage surrounding tumor tissue leading to improved efficacy of cytotoxic drugs rather than a pathway of lymphatic metastasis. Although the current results should be validated in the future, they may help clinicians further understand the mechanism of chemo-resistance6 and the role of peritumoral LVs in EC patients. DISCLOSURES
There are no conflicts of interest.
REFERENCES Ă“ Society of
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