Outcomes of patients with submucosal (T1b) esophageal adenocarcinoma: a multicenter cohort study.

Autor: Otaki F; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Ma GK; Division of Gastroenterology, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA., Krigel A; Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA., Dierkhising RA; Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA., Lewis JT; Department of Laboratory Medicine and Anatomic Pathology, Mayo Clinic College of Medicine, Jacksonville, Florida, USA., Blevins CH; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Gopalakrishnan NP; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Ravindran A; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Johnson ML; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Leggett CL; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Wigle D; Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota, USA., Wang KK; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Falk GW; Division of Gastroenterology, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA., Abrams JA; Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA., Nakagawa H; Division of Gastroenterology, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA., Rustgi AK; Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA., Wang TC; Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA., Lightdale CJ; Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA., Ginsberg GG; Division of Gastroenterology, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA., Iyer PG; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Jazyk: angličtina
Zdroj: Gastrointestinal endoscopy [Gastrointest Endosc] 2020 Jul; Vol. 92 (1), pp. 31-39.e1. Date of Electronic Publication: 2020 Jan 15.
DOI: 10.1016/j.gie.2020.01.013
Abstrakt: Background and Aims: The treatment of submucosal (T1b) esophageal adenocarcinoma (EAC) remains in evolution, with some evidence supporting endoscopic management of low-risk lesions. Using a multicenter cohort, we evaluated outcomes of patients with T1b EAC and predictors of survival.
Methods: Patients diagnosed between 2001 and 2016 with T1b EAC were identified from 3 academic medical centers in the United States. Demographic, clinical, and outcome data were collected. Outcomes studied were overall and cancer-free survival. Cox proportional hazards models were constructed to assess independent predictors of survival.
Results: One hundred forty-one patients were included, of whom 68 (48%) underwent esophagectomy and 73 (52%) were treated endoscopically. Most patients (85.8%) had high-risk histologic features. Thirty-day operative mortality was 2.9%. Median follow-up in the esophagectomy and endoscopic cohorts was 49.4 and 43.4 months, respectively. Patients treated endoscopically were older with higher comorbidity scores, with 46 (63%) achieving histologic remission. Nineteen patients (26.0%) also received chemoradiation. Five-year overall survival rates in the surgical and endoscopic cohorts were 89% and 59%, respectively, whereas 5-year cancer-free survival rates were 92% and 69%. Presence of high-risk histologic features was associated with reduced overall survival.
Conclusions: In this large multicenter study of patients with T1b EAC, esophagectomy was associated with improved overall but not cancer-free survival. High-risk histologic features were associated with poorer survival.
(Copyright © 2020 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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