Analysis of metastases rates during follow-up after endoscopic resection of early "high-risk" esophageal adenocarcinoma.

Adenocarcinoma / pathology Endoscopy Esophageal Neoplasms / pathology Follow-Up Studies Humans Neoplasm Invasiveness Prospective Studies Retrospective Studies

Journal

Gastrointestinal endoscopy
ISSN: 1097-6779
Titre abrégé: Gastrointest Endosc
Pays: United States
ID NLM: 0010505

Informations de publication

Date de publication:
08 2022
Historique:
received: 22 11 2021
accepted: 04 03 2022
pubmed: 16 3 2022
medline: 20 7 2022
entrez: 15 3 2022
Statut: ppublish

Résumé

After endoscopic resection (ER) of early esophageal adenocarcinoma (EAC), the optimal management of patients with high-risk histologic features for lymph node metastases (ie, submucosal invasion, poor differentiation grade, or lymphovascular invasion) remains unclear. We aimed to evaluate outcomes of endoscopic follow-up after ER for high-risk EAC. For this retrospective cohort study, data were collected from all Dutch patients managed with endoscopic follow-up (endoscopy, EUS) 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. The primary outcome was the annual risk for metastases during follow-up, stratified for baseline histology. One hundred twenty patients met the selection criteria. Median follow-up was 29 months (interquartile range, 15-48). Metastases were observed in 5 of 25 (annual risk, 6.9%; 95% confidence interval [CI], 3.0-15) high-risk intramucosal cancers, 1 of 55 (annual risk, .7%; 95% CI, 0-4.0) low-risk submucosal cancers, and 3 of 40 (annual risk, 3.0%; 95% CI, 0-7.0) high-risk submucosal cancers. 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.

Sections du résumé

BACKGROUND AND AIMS
After endoscopic resection (ER) of early esophageal adenocarcinoma (EAC), the optimal management of patients with high-risk histologic features for lymph node metastases (ie, submucosal invasion, poor differentiation grade, or lymphovascular invasion) remains unclear. We aimed to evaluate outcomes of endoscopic follow-up after ER for high-risk EAC.
METHODS
For this retrospective cohort study, data were collected from all Dutch patients managed with endoscopic follow-up (endoscopy, EUS) 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. The primary outcome was the annual risk for metastases during follow-up, stratified for baseline histology.
RESULTS
One hundred twenty patients met the selection criteria. Median follow-up was 29 months (interquartile range, 15-48). Metastases were observed in 5 of 25 (annual risk, 6.9%; 95% confidence interval [CI], 3.0-15) high-risk intramucosal cancers, 1 of 55 (annual risk, .7%; 95% CI, 0-4.0) low-risk submucosal cancers, and 3 of 40 (annual risk, 3.0%; 95% CI, 0-7.0) high-risk submucosal cancers.
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.

Identifiants

DOI: 10.1016/j.gie.2022.03.005 PMID: 35288149
pubmed: 35288149
pii: S0016-5107(22)00195-X
doi: 10.1016/j.gie.2022.03.005
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

237-247.e3

Investigateurs

A Karrenbeld (A)
A Ooms (A)
C Huysentruyt (C)
F Ten Kate (F)
F Moll (F)
G Kats-Ugurlu (G)
I van Lijnschoten (I)
J van de Laan (J)
J Offerhaus (J)
K Biermann (K)
K Seldenrijk (K)
L Brosens (L)
S Meijer (S)
M Doukas (M)

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Informations de copyright

Copyright © 2022 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Auteurs

Esther A Nieuwenhuis (EA)

Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Cancer Center Amsterdam, Amsterdam University Medical Centers, location VUMC, Amsterdam, the Netherlands.

Sanne N van Munster (SN)

Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Cancer Center Amsterdam, Amsterdam University Medical Centers, location VUMC, Amsterdam, the Netherlands.

Sybren L Meijer (SL)

Department of Pathology, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands.

Lodewijk A A Brosens (LAA)

Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.

Marnix Jansen (M)

Department of Pathology, UCL Cancer Institute and University College London Hospital, NHS Trust, London, UK.

Bas L A M Weusten (BLAM)

Department of Gastroenterology and Hepatology University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, the Netherlands.

Lorenza Alvarez Herrero (L)

Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, the Netherlands.

Alaa Alkhalaf (A)

Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, the Netherlands.

Ed Schenk (E)

Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, the Netherlands.

Erik J Schoon (EJ)

GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands; Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands.

Wouter L Curvers (WL)

Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands.

Arjun D Koch (AD)

Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.

Steffi E M van de Ven (SEM)

Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.

Eva P D Verheij (EPD)

Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Cancer Center Amsterdam, Amsterdam University Medical Centers, location VUMC, Amsterdam, the Netherlands.

Wouter B Nagengast (WB)

Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen University, Groningen, the Netherlands, (12)Department of Gastroenterology and Hepatology, Haga Teaching Hospital, Den Haag, the Netherlands.

Jessie Westerhof (J)

Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen University, Groningen, the Netherlands, (12)Department of Gastroenterology and Hepatology, Haga Teaching Hospital, Den Haag, the Netherlands.

Martin H M G Houben (MHMG)

Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen University, Groningen, the Netherlands, (12)Department of Gastroenterology and Hepatology, Haga Teaching Hospital, Den Haag, the Netherlands.

Thjon Tang (T)

Department of Gastroenterology and Hepatology, Ijsselland Hospital, Capelle aan den Ijssel, the Netherlands.

Jacques J G H M Bergman (JJGHM)

Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Cancer Center Amsterdam, Amsterdam University Medical Centers, location VUMC, Amsterdam, the Netherlands.

Roos E Pouw (RE)

Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Cancer Center Amsterdam, Amsterdam University Medical Centers, location VUMC, Amsterdam, the Netherlands.

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Classifications MeSH

questionsmedicales.fr › Tumeurs › Tumeurs par type histologique › Tumeurs épithéliales épidermoïdes et glandulaires › Carcinomes › Adénocarcinome › Analysis of metastases rates during follow-up...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Endoscopie › Analysis of metastases rates during follow-up...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Tumeurs gastro-intestinales › Tumeurs de l'oesophage › Analysis of metastases rates during follow-up...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études de suivi › Analysis of metastases rates during follow-up...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Analysis of metastases rates during follow-up...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Processus néoplasiques › Invasion tumorale › Analysis of metastases rates during follow-up...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Analysis of metastases rates during follow-up...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Analysis of metastases rates during follow-up...