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©The Author(s) 2016.
World J Gastrointest Endosc. Dec 16, 2016; 8(20): 763-769
Published online Dec 16, 2016. doi: 10.4253/wjge.v8.i20.763
Published online Dec 16, 2016. doi: 10.4253/wjge.v8.i20.763
Table 1 Characteristics of T1b esophageal adenocarcinoma by treatment modality following endoscopic mucosal resection
Group A (n = 16) | Group B (n = 9) | Group C (n = 7) | Group D (n = 21) | Overall (n = 53) | |
Average age, yr | 75 ± 78 | 70 ± 14 | 62 ± 5 | 72 ± 13 | 71 ± 12 |
Median follow-up after EMR, mo (range) | 34 (12-102) | 27 (12-56) | 49 (13-103) | N/A | 34 (12-103) (for groups A-C, n = 32) |
EMR method, n (%) | |||||
Cap | 6 (38) | 0 (0) | 2 (29) | 4 (19) | 12 (23) |
Band | 10 (62) | 9 (100) | 5 (71) | 17 (81) | 41 (77) |
Pathology depth, n (%) | |||||
sm1 | 6 (38) | 4 (44) | 1 (14) | 2 (10) | 13 (25) |
sm2/3 | 10 (62) | 5 (56) | 6 (86) | 19 (90) | 40 (75) |
Tumor location, n (%) | |||||
Proximal two-thirds | 2 (13) | 1 (11) | 1 (14) | 5 (24) | 9 (17) |
Distal one-third | 14 (88) | 8 (89) | 6 (86) | 16 (76) | 44 (83) |
LPI, n (%) | |||||
Yes | 1 (6) | 1 (11) | 0 (0) | 3 (14) | 5 (9) |
No | 15 (94) | 8 (89) | 7 (100) | 18 (86) | 48 (91) |
Differentiation, n (%) | |||||
Well-moderate | 14 (88) | 6 (67) | 7 (100) | 15 (71) | 42 (79) |
Poor | 2 (13) | 3 (33) | 0 (0) | 6 (29) | 11 (21) |
EMR margins for cancer, n (%) | |||||
Deep -/lateral - | 6 (38) | 2 (22) | 1 (14) | 2 (10) | 11 (21) |
Deep -/lateral + | 5 (31) | 1 (11) | 1 (14) | 4 (19) | 11 (21) |
Deep +/lateral + | 4 (25) | 6 (66) | 5 (71) | 13 (62) | 28 (53) |
Deep +/lateral - | 1 (6) | 0 (0) | 0 (0) | 2 (10) | 3 (6) |
Recurrences, n (%) | |||||
Yes | 6 (38) | 1 (11) | 2 (29) | N/A | 9 (28) |
No | 10 (63) | 8 (88) | 5 (71) | 23 (72) | |
Median time to recurrence (mo, range) | 21 (6-73) | 30 (30-30) | 21 (7-35) | 21 (6-73) (for groups A-C, n = 32) | |
Location of recurrence | |||||
Local | 5 | 0 | 1 | N/A | 6 |
Metastatic | 1 | 1 | 1 | 3 |
Table 2 Recurrence rates of esophageal adenocarcinoma by investigated risk factors of esophageal adenocarcinoma (n = 32) n (%)
Variable | Recurrence rates | P value |
EMR method | ||
Cap | 4/8 (50) | 0.18 |
Band | 5/24 (21) | |
Pathology depth | ||
sm1 | 3/11 (27) | 0.11 |
sm2/3 | 6/21 (29) | |
Tumor location | ||
Proximal 2/3 esophagus | 2/4 (50) | 0.56 |
Distal 1/3 esophagus | 7/28 (25) | |
LPI | ||
Yes | 0/2 (0) | 1.00 |
No | 9/30 (30) | |
Differentiation | ||
Well-moderate | 8/27 (30) | 1.00 |
Poor | 1/5 (20) | |
Deep EMR margins | ||
Positive | 4/16 (25) | 1.00 |
Negative | 5/16 (31) | |
Lateral EMR margins | ||
Positive | 6/22 (27) | 1.00 |
Negative | 3/10 (30) | |
Primary treatment | ||
Endoscopic +/- CRT | 7/25 (28) | 1.00 |
Surgical | 2/7 (29) |
Table 3 Endoscopic ultrasound staging/path accuracy for T1b esophageal adenocarcinoma
EUS staging (n = 51) | Pathologic staging | ||
pT1sm1 (n = 12) | pT1sm2/3 (n = 39) | Overall (all pT1b) (n = 51) | |
uT0 Nx | 0 | 1 | 1 |
uT1 Nx | 11 | 36 | 47 |
uT2 Nx | 1 | 2 | 3 |
T staging accuracy | 91.7% | 92.3% | 92.2% |
Table 4 Studies evaluating endoscopic management of T1b esophageal adenocarcinoma
Ref. | # Patients | Depth of invasion | Histology | Margins | Remission | Recurrence | Survival |
Manner et al[12] | 21 | sm1 | Well to moderately differentiated, no lymphovascular invasion | Lateral margins negative in 12 | 95% at mean 5.3 mo | 28% at mean 62 mo (range 45-89) | 67% estimated 5-yr survival |
Alvarez Herrero et al[14] | 18 | sm1 and sm2/3 | Well, moderately and poorly differentiated, some with lymphovascular invasion | Not reported | Not reported | 17% | Not reported |
Tian et al[15] | 29 | sm1 and sm2-3 | Not reported | Not reported | Not reported | Not reported | 62% with median duration 34.8 mo |
Manner et al[13] | 66 | sm1 | Well to moderately differentiated, no lymphovascular invasion | Not reported | 84% at mean 4.5 mo | 21% at mean 22 mo (range 6-60) | 84% estimated 5-yr survival |
- Citation: Ballard DD, Choksi N, Lin J, Choi EY, Elmunzer BJ, Appelman H, Rex DK, Fatima H, Kessler W, DeWitt JM. Outcomes of submucosal (T1b) esophageal adenocarcinomas removed by endoscopic mucosal resection. World J Gastrointest Endosc 2016; 8(20): 763-769
- URL: https://www.wjgnet.com/1948-5190/full/v8/i20/763.htm
- DOI: https://dx.doi.org/10.4253/wjge.v8.i20.763