Risk of metastasis among patients diagnosed with high-risk T1 esophageal adenocarcinoma who underwent endoscopic follow-up

被引:1
作者
Norton, Benjamin Charles [1 ,2 ,3 ,5 ]
Aslam, Nasar [1 ]
Telese, Andrea [1 ,2 ]
Papaefthymiou, Apostolis [1 ]
Singh, Shilpi [4 ]
Sehgal, Vinay [1 ]
Mitchison, Miriam [4 ]
Jansen, Marnix [4 ]
Banks, Matthew [1 ]
Graham, David [1 ]
Haidry, Rehan [3 ]
机构
[1] Univ Coll London Hosp, Dept Gastroenterol, London, England
[2] UCL, Ctr Obes Res, London, England
[3] Cleveland Clin London, Digest Dis & Surg Inst, Dept Gastroenterol, London, England
[4] Univ Coll London Hosp, Dept Histopathol, London, England
[5] Univ Coll London Hosp, Dept Gastroenterol, Euston Rd, London NW1 2BU, England
关键词
LYMPH-NODE METASTASIS; RADIOFREQUENCY ABLATION; MUCOSAL ADENOCARCINOMA; SUBMUCOSAL INVASION; BARRETTS-ESOPHAGUS; MANAGEMENT; NEOPLASIA; RESECTION; OUTCOMES; THERAPY;
D O I
10.1093/dote/doae027
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Esophagectomy and lymphadenectomy have been the standard of care for patients at high risk (HR) of lymph node metastasis following a diagnosis of early esophageal adenocarcinoma (OAC) after endoscopic resection (ER). However, recent cohorts suggest lymph node metastasis risk is lower than initially estimated, suggesting organ preservation with close endoscopic follow-up is a viable option. We report on the 3- and 5-year risk of lymph node/distant metastasis among patients diagnosed with early HR-T1 OAC undergoing endoscopic follow-up. Patients diagnosed with HR-T1a or T1b OAC following ER at a tertiary referral center were identified and retrospectively analyzed from clinical records between 2010 and 2021. Patients were included if they underwent endoscopic follow-up after resection and were divided into HR-T1a, low risk (LR)-T1b and HR-T1b cohorts. After ER, 47 patients underwent endoscopic follow-up for early HR OAC. In total, 39 patients had an R0 resection with a combined 3- and 5-year risk of LN/distant metastasis of 6.9% [95% confidence interval (CI): 1.8-25] and 10.9% (95% CI, 3.6-30.2%), respectively. There was no significant difference when stratifying by histopathological subtype (P = 0.64). Among those without persistent luminal disease on follow-up, the 5-year risk was 4.1% (95% CI, 0.6-26.1). Two patients died secondary to OAC with an all-cause 5-year survival of 57.5% (95% CI, 39.5-71.9). The overall risk of LN/distant metastasis for early HR T1 OAC was lower than historically reported. Endoscopic surveillance can be a reasonable approach in highly selected patients with an R0 resection and complete luminal eradication, but clear, evidence-based surveillance guidelines are needed.
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