Article ; Online: Clinical Outcomes After Endoscopic Management of Low-Risk and High-Risk T1a Esophageal Adenocarcinoma: A Multicenter Study.
The American journal of gastroenterology
2023 Volume 119, Issue 4, Page(s) 662–670
Abstract: Introduction: Endoscopic eradication therapy (EET) is standard of care for T1a esophageal adenocarcinoma (EAC). However, data on outcomes in high-risk T1a EAC are limited. We assessed and compared outcomes after EET of low-risk and high-risk T1a EAC, ... ...
| Abstract | Introduction: Endoscopic eradication therapy (EET) is standard of care for T1a esophageal adenocarcinoma (EAC). However, data on outcomes in high-risk T1a EAC are limited. We assessed and compared outcomes after EET of low-risk and high-risk T1a EAC, including intraluminal EAC recurrence, extraesophageal metastases, and overall survival. Methods: Patients who underwent EET for T1a EAC at 3 referral Barrett's esophagus endotherapy units between 1996 and 2022 were included. Patients with submucosal invasion, positive deep margins, or metastases at initial diagnosis were excluded. High-risk T1a EAC was defined as T1a EAC with poor differentiation and/or lymphovascular invasion, with low-risk disease being defined without these features. All pathology was systematically assessed by expert gastrointestinal pathologists. Baseline and follow-up endoscopy and pathology data were abstracted. Time-to-event analyses were performed to compare outcomes between groups. Results: One hundred eighty-eight patients with T1a EAC were included (high risk, n = 45; low risk, n = 143) with a median age of 70 years, and 84% were men. Groups were comparable for age, sex, Barrett's esophagus length, lesion size, and EET technique. Rates of delayed extraesophageal metastases (11.1% vs 1.4%) were significantly higher in the high-risk group ( P = 0.02). There was no significant difference in the rates of intraluminal EAC recurrence ( P = 0.79) and overall survival ( P = 0.73) between the 2 groups. Discussion: Patients with high-risk T1a EAC undergoing successful EET had a substantially higher rate of extraesophageal metastases compared with those with low-risk T1a EAC on long-term follow-up. These data should be factored into discussions with patients while selecting treatment approaches. Additional prospective data in this area are critical. |
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| MeSH term(s) | Male ; Humans ; Aged ; Female ; Barrett Esophagus/surgery ; Barrett Esophagus/pathology ; Prospective Studies ; Esophageal Neoplasms/pathology ; Adenocarcinoma/pathology ; Endoscopy, Gastrointestinal |
| Language | English |
| Publishing date | 2023-10-05 |
| Publishing country | United States |
| Document type | Multicenter Study ; Journal Article |
| ZDB-ID | 390122-1 |
| ISSN | 1572-0241 ; 0002-9270 |
| ISSN (online) | 1572-0241 |
| ISSN | 0002-9270 |
| DOI | 10.14309/ajg.0000000000002554 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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