{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:40:35Z","timestamp":1790311235748,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The incidence of lymph node metastasis (LNM) in early stage esophageal adenocarcinoma (EAC) is up to 45% based on high\u2010risk pathologic features. This risk has not been determined following external validation of staging and pathologic features.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with clinical T1 EAC who underwent surgical resection at a single institution from 1999 to 2023 were included. Before inclusion, all retrospective data was validated by an external reviewer within the institution. Patients were categorized into low\u2010risk and high\u2010risk categories. Incidence of LNM was examined using univariate analyses. Survival analysis was performed with Kaplan Meier survival estimates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>66 patients underwent esophagectomy and had multidisciplinary validation of staging and pathologic data; 28 (42.4%) patients had pT1b and 11\/28 (39.3%) had SM3 tumors. The LNM rate was 10.6%; the incidence of LNM was higher for T1b compared to T1a (17.9%, <jats:italic>N<\/jats:italic>\u2009=\u20095\/28 vs 5.3%, <jats:italic>N<\/jats:italic>\u2009=\u20092\/38, p 0.10) tumors. Low\u2010risk pT1a and high\u2010risk pT1b patients had a LNM rates of 3.3% and 21.7%, respectively. Following a median follow\u2010up of 46 months, there was no significant difference in overall survival and recurrence\u2010free survival across risk stratification groups and comparing patients with and without LNM. Sensitivity for staging of T1b tumors was poor (40.9%, 50%, and 82.1%, respectively) for chest\/abdominal CT, PET\/CT, and EUS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>T1 EAC patients retrospectively reviewed for multidisciplinary validation of staging and pathologic data have a LNM risk up to 21.7% when stratified by risk factors with a clinical trend toward worse survival. High\u2010risk T1b patients may warrant neoadjuvant chemoradiotherapy before surgical resection.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.70050","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T07:30:11Z","timestamp":1753687811000},"page":"754-762","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Analysis of the Incidence of Lymph Node Metastases in High\u2010Risk Early Stage (T1) Esophageal Adenocarcinomas: A Single\u2010Institution Experience"],"prefix":"10.1002","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7812-9627","authenticated-orcid":false,"given":"Adrienne B.","family":"Shannon","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal Oncology Moffitt Cancer Center Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwa A.","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Department of Radiology University of South Florida Morsani College of Medicine Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y.","family":"Lauwers","sequence":"additional","affiliation":[{"name":"Department of Anatomic Pathology Moffitt Cancer Center Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis R.","family":"Pena","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Oncology Moffitt Cancer Center Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaffer R.","family":"Mok","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Oncology Moffitt Cancer Center Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6031-6451","authenticated-orcid":false,"given":"Andrew J.","family":"Sinnamon","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Oncology Moffitt Cancer Center Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrillo R.","family":"Araujo","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging and Interventional Radiology Moffitt Cancer Center Tampa Florida USA"},{"name":"Department of Oncologic Sciences University of South Florida Morsani College of Medicine Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose M.","family":"Pimiento","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Oncology Moffitt Cancer Center Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1053\/j.gastro.2022.05.054","article-title":"The Global Landscape of Esophageal Squamous Cell Carcinoma and Esophageal Adenocarcinoma Incidence and Mortality in 2020 and Projections to 2040: New Estimates From GLOBOCAN 2020","volume":"163","author":"Morgan E.","year":"2022","journal-title":"Gastroenterology"},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1007\/s10552-021-01443-z","article-title":"Trends in Esophageal Cancer Mortality and Stage at Diagnosis by Race and Ethnicity in the United States","volume":"32","author":"Corona E.","year":"2021","journal-title":"Cancer Causes & Control"},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"315","DOI":"10.5009\/gnl18254","article-title":"Management of Clinical T1N0M0 Esophageal Cancer","volume":"13","author":"Yang A. 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