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

• Published in: Gastrointestinal endoscopy 2020-07, Vol.92 (1), p.31-39.e1
• Main Authors: Otaki, Fouad, Ma, Gene K., Krigel, Anna, Dierkhising, Ross A., Lewis, Jason T., Blevins, Christopher H., Gopalakrishnan, Naveen P., Ravindran, Adharsh, Johnson, Michele L., Leggett, Cadman L., Wigle, Denis, Wang, Kenneth K., Falk, Gary W., Abrams, Julian A., Nakagawa, Hiroshi, Rustgi, Anil K., Wang, Timothy C., Lightdale, Charles J., Ginsberg, Gregory G., Iyer, Prasad G.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - pathology; Aged; Cohort Studies; Esophageal Neoplasms - pathology; Esophagectomy; Female; Humans; Male; Middle Aged; Neoplasm Staging; Retrospective Studies; United States
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2020.01.013

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. 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. 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. 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.