Nieuwenhuis, Esther A;
van Munster, Sanne N;
Meijer, Sybren L;
Brosens, Lodewijk AA;
Jansen, Marnix;
Weusten, Bas LAM;
Herrero, Lorenza Alvarez;
... Dutch Barrett Expert Centers, .; + view all
(2022)
Analysis of metastases rates during follow-up after endoscopic resection of early "high-risk" esophageal adenocarcinoma.
Gastrointestinal Endoscopy
, 96
(2)
237-247.e3.
10.1016/j.gie.2022.03.005.
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Abstract
BACKGROUND AND AIMS: After endoscopic resection (ER) of early esophageal adenocarcinoma (EAC), the optimal management of patients with high-risk histological features for lymph node metastases (LNM) (i.e., submucosal invasion, poor differentiation grade, or lymphovascular invasion (LVI)), remains unclear. We aimed to evaluate outcomes of endoscopic follow-up after ER for high-risk EAC. METHODS: For this retrospective cohort study, data was collected from all Dutch patients managed with endoscopic follow-up (endoscopy, endoscopic ultrasound) after ER for high-risk EAC between 2008 and 2019. We distinguished 3 groups: intramucosal cancers with high-risk features, submucosal cancers with low-risk features, and submucosal cancers with high-risk features. Primary outcome was the annual risk for metastases during follow-up, stratified for baseline histology. RESULTS: A total of 120 patients met the selection criteria. Median FU was 29 months (IQR 15-48). Metastases were observed in 5/25 (annual risk 6.9%; 95% CI 3.0-15), 1/55 (annual risk 0.7%; 95% CI 0-4.0) and 3/40 (annual risk 3.0%; 95% CI 0-7.0) in high-risk intramucosal, low-risk submucosal, and high-risk submucosal cancers, respectively. CONCLUSIONS: Whereas the annual metastasis rate for high-risk submucosal EAC (3.0%) was somewhat lower than expected in comparison with previous reported percentages, the annual metastasis rate of 6.9% for high-risk intramucosal EAC is new and worrisome. This calls for further prospective studies and suggests that strict follow-up of this small subgroup is warranted until prospective data are available.
| Type: | Article |
|---|---|
| Title: | Analysis of metastases rates during follow-up after endoscopic resection of early "high-risk" esophageal adenocarcinoma |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.gie.2022.03.005 |
| Publisher version: | https://doi.org/10.1016/j.gie.2022.03.005 |
| Language: | English |
| Additional information: | © 2022 by the American Society for Gastrointestinal Endoscopy. Published by Elsevier, Inc. under a Creative Commons license (https://creativecommons.org/licenses/by/4.0/). |
| Keywords: | endoscopic therapy, esophageal adenocarcinoma, histopathological risk factors, metastases |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute > Research Department of Pathology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10149603 |
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