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.

中文翻译：

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黏膜下（T1b）食管腺癌患者的结局：一项多中心队列研究。

背景和目标

粘膜下（T1b）食管腺癌（EAC）的治疗仍在发展中，有一些证据支持低风险病变的内镜治疗。使用多中心队列，我们​​评估了T1b EAC患者的预后和生存预测因素。

方法

从美国3个学术医学中心鉴定出2001年至2016年之间诊断为T1b EAC的患者。收集了人口统计学，临床和结局数据。研究的结果是总体生存率和无癌症生存率。构建考克斯比例风险模型以评估生存的独立预测因子。

结果

其中包括一百四十一例患者，其中68例（48％）接受了食管切除术，其中73例（52％）接受了内镜治疗。大多数患者（85.8％）具有高风险的组织学特征。30天手术死亡率为2.9％。食管切除术和内镜组的中位随访时间分别为49.4和43.4个月。经内镜治疗的患者年龄较大，合并症评分较高，其中46（63％）名患者达到了组织学缓解。19名患者（26.0％）也接受了化学放射治疗。手术组和内镜组的五年总生存率分别为89％和59％，而五年无癌生存率分别为92％和69％。高危组织学特征的存在与总体生存期降低有关。

结论

在这项针对T1b EAC患者的大型多中心研究中，食管切除术可改善总体生存率，但与无癌症生存率相关。高风险的组织学特征与较差的生存有关。