Defining low-risk lesions in early-stage esophageal adenocarcinoma.
Adenocarcinoma
/ epidemiology
Aged
Esophageal Neoplasms
/ epidemiology
Esophagectomy
/ adverse effects
Esophagoscopy
/ methods
Humans
Incidence
Lymphatic Metastasis
/ diagnosis
Neoplasm Recurrence, Local
/ epidemiology
Neoplasm Staging
New York
/ epidemiology
Organ Sparing Treatments
Patient Selection
Reproducibility of Results
Risk Assessment
/ methods
Risk Factors
Tumor Burden
esophageal adenocarcinoma, recurrence, surgical resection
Journal
The Journal of thoracic and cardiovascular surgery
ISSN: 1097-685X
Titre abrégé: J Thorac Cardiovasc Surg
Pays: United States
ID NLM: 0376343
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
received:
18
02
2020
revised:
15
10
2020
accepted:
21
10
2020
pubmed:
19
12
2020
medline:
1
10
2021
entrez:
18
12
2020
Statut:
ppublish
Résumé
As endoscopic approaches become more widely used to treat early-stage esophageal cancer, reliably identifying patients with less-aggressive tumors is paramount. We sought to identify risk factors for recurrence in patients with completely resected T1 esophageal adenocarcinoma. We retrospectively analyzed a single-institutional database for all patients with completely resected pathologic T1 esophageal adenocarcinoma (1996-2016). Risk factors for recurrence were identified using competing-risk regression methods. Risk stratification was performed on the basis of known preoperative clinicopathologic factors; this model's discriminative power for overall survival was evaluated using a Cox proportional hazards model. Of 243 patients, 32 experienced recurrence. At a median follow-up among survivors of 4 years (range, 0.05-19 years), the 5-year cumulative incidence of recurrence was 15%, and median time to recurrence was 2 years (range, 0.26-6.13 years). On univariable analysis, submucosal invasion, N1 disease, poor differentiation, tumor length, lymphovascular invasion, and multicentricity were significantly associated with recurrence. On multivariable analysis, N1 disease (hazard ratio, 2.93; 95% confidence interval, 1.17-7.34; P = .022) and tumor length (hazard ratio, 1.44; 95% confidence interval, 1.12-1.86; P = .004) were independently associated with recurrence. Risk stratification showed that patients without lymphovascular invasion and a with median tumor length of 0.8 cm (range, 0.10-1.70 cm) had a <10% risk of recurrence and improved survival. Pathologic T1 tumors have a 5-year cumulative incidence of recurrence of 15%. Nodal involvement and tumor length were independent risk factors for recurrence, whereas tumors <2 cm in length without lymphovascular invasion were associated with a low risk of recurrence.
Identifiants
pubmed: 33334599
pii: S0022-5223(20)33097-X
doi: 10.1016/j.jtcvs.2020.10.138
pmc: PMC8141543
mid: NIHMS1696168
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1272-1279Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
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