INTRODUCTION Endoscopic eradication therapy (EET) is standard of care for T1a esophageal adenocarcinoma (EAC). However, data on outcomes in high-risk T1a EAC are limited. We assessed and compared outcomes after EET of low-risk and high-risk T1a EAC, including intraluminal EAC recurrence, extraesophageal metastases, and overall survival. METHODS Patients who underwent EET for T1a EAC at 3 referral Barrett's esophagus endotherapy units between 1996 and 2022 were included. Patients with submucosal invasion, positive deep margins, or metastases at initial diagnosis were excluded. High-risk T1a EAC was defined as T1a EAC with poor differentiation and/or lymphovascular invasion, with low-risk disease being defined without these features. All pathology was systematically assessed by expert gastrointestinal pathologists. Baseline and follow-up endoscopy and pathology data were abstracted. Time-to-event analyses were performed to compare outcomes between groups. RESULTS One hundred eighty-eight patients with T1a EAC were included (high risk, n = 45; low risk, n = 143) with a median age of 70 years, and 84% were men. Groups were comparable for age, sex, Barrett's esophagus length, lesion size, and EET technique. Rates of delayed extraesophageal metastases (11.1% vs 1.4%) were significantly higher in the high-risk group ( P = 0.02). There was no significant difference in the rates of intraluminal EAC recurrence ( P = 0.79) and overall survival ( P = 0.73) between the 2 groups. DISCUSSION Patients with high-risk T1a EAC undergoing successful EET had a substantially higher rate of extraesophageal metastases compared with those with low-risk T1a EAC on long-term follow-up. These data should be factored into discussions with patients while selecting treatment approaches. Additional prospective data in this area are critical.

中文翻译：

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低风险和高风险 T1a 食管腺癌内镜治疗后的临床结果：一项多中心研究。

简介 内镜根除治疗 (EET) 是 T1a 食管腺癌 (EAC) 的标准治疗方法。然而，有关高风险 T1a EAC 结果的数据有限。我们评估并比较了低风险和高风险 T1a EAC 的 EET 后结果，包括管腔内 EAC 复发、食管外转移和总体生存率。方法 1996 年至 2022 年间，在 3 个转诊 Barrett 食管内治疗单位接受 EET 治疗 T1a EAC 的患者被纳入研究。排除初次诊断时有粘膜下侵犯、深切缘阳性或转移的患者。高风险 T1a EAC 被定义为分化不良和/或淋巴血管侵犯的 T1a EAC，低风险疾病被定义为没有这些特征。所有病理学均由胃肠病理学家专家进行系统评估。提取基线和随访内窥镜检查和病理学数据。进行事件发生时间分析以比较各组之间的结果。结果 纳入 188 名 T1a EAC 患者（高风险，n = 45；低风险，n = 143），中位年龄为 70 岁，其中 84% 为男性。各组在年龄、性别、Barrett 食管长度、病变大小和 EET 技术方面具有可比性。高危组的迟发性食管外转移率（11.1% vs 1.4%）显着较高（P = 0.02）。两组间EAC管腔内复发率（P=0.79）和总生存率（P=0.73）无显着差异。讨论 在长期随访中，与低风险 T1a EAC 患者相比，接受成功 EET 的高风险 T1a EAC 患者食管外转移率明显更高。在选择治疗方法时应将这些数据纳入与患者的讨论中。该领域的其他前瞻性数据至关重要。