Clinicopathological significance of tumor nest configuration in patients with esophageal squamous cell carcinoma.

Abstract

Cancer-stromal interactions are an important mediator of cancer invasion and metastasis. The authors investigated the clinicopathological significance of tumor nest configuration and the surrounding stroma in 159 patients with advanced esophageal squamous cell carcinoma (ESCC). The tumors were classified microscopically into two types. Type A tumors had oval-shaped or sheet-like tumor nests (with > 80% of the tumor area showing these features). Type B tumors had asteroid-shaped or scattered small tumor nests (with > 20% of the tumor area showing these features). Of the 159 tumors examined, 38 (24%) were type A and 121 (76%) were type B. Type B tumors had a significantly deeper invasion depth, more frequent lymphatic permeation and lymph node metastasis, more prominent active fibroblastic stroma, and less frequent inflammatory cell infiltration (P < 0.05). Both univariate (P < 0.05) and multivariate (P < 0.05) analysis of the patients' survival showed that the prognosis for patients with type B tumors was significantly worse than for patients with type A tumors. This study showed that tumor nest configuration, which corresponded to the behavior of tumor cells against stromal cells, correlated well with the aggressiveness of the tumor.