Defining low-risk lesions in early-stage esophageal adenocarcinoma Journal Article
| Authors: | Sihag, S.; De La Torre, S.; Hsu, M.; Nobel, T.; Tan, K. S.; Gerdes, H.; Shah, P.; Bains, M.; Jones, D. R.; Molena, D. |
| Article Title: | Defining low-risk lesions in early-stage esophageal adenocarcinoma |
| Abstract: | Objective: 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. Methods: 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. Results: 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. Conclusions: 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. © 2020 The American Association for Thoracic Surgery |
| Keywords: | esophageal adenocarcinoma, recurrence, surgical resection |
| Journal Title: | Journal of Thoracic and Cardiovascular Surgery |
| Volume: | 162 |
| Issue: | 4 |
| ISSN: | 0022-5223 |
| Publisher: | Mosby Elsevier |
| Date Published: | 2021-10-01 |
| Start Page: | 1272 |
| End Page: | 1279 |
| Language: | English |
| DOI: | 10.1016/j.jtcvs.2020.10.138 |
| PUBMED: | 33334599 |
| PROVIDER: | scopus |
| PMCID: | PMC8141543 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 October 2021 -- Source: Scopus |
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