Clinical and Histologic Determinants of Mortality for Patients With Barrett's Esophagus-Related T1 Esophageal Adenocarcinoma

Cadman Leggett, Jason T. Lewis, Tsung Teh Wu, Cathy D. Schleck, Alan R. Zinsmeister, Kelly T. Dunagan, Lori S. Lutzke, Kenneth Ke Ning Wang, Prasad G Iyer

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background and Aims: Superficial (T1) esophageal adenocarcinoma (EAC) commonly is treated by endoscopic resection, yet little is known about factors that predict outcomes of this approach. We assessed clinical and histologic variables associated with the overall survival times of patients with T1 EAC who received therapy. Methods: In a retrospective analysis, we collected data from patients who underwent endoscopic mucosal resection (EMR) for T1 EAC (194 patients with T1a and 75 patients with T1b) at the Mayo Clinic, from 1995 through 2011. EMR specimens were reviewed systematically for depth of invasion, presence of lymphovascular invasion, grade of differentiation, and status of resection margins. Kaplan-Meier curves and proportional hazards regression models were used in statistical analyses. Results: Demographic characteristics were similar between patients with T1a and T1b EAC. Overall survival at 5 years after EMR was 74.4% for patients with T1a (95% confidence interval [CI], 67.6%-81.8%) and 53.2% for patients with T1b EAC (95% CI, 40.3%-70.1%). Of surviving patients with T1a EAC, 94.1% remained free of cancer (95% CI, 89.8%-98.5%), and 94.7% of surviving patients with T1b EAC remained free of cancer (95% CI, 85.2%-100%). A multivariable model associated older age (per 10-year increment), evidence of lymphovascular invasion, and deep margin involvement with reduced overall survival in patients with T1 EAC. Conclusions: Systematic assessment of EMR specimens can help predict mortality and potentially guide treatment options for patients with T1 EAC.

Original languageEnglish (US)
Pages (from-to)658-664
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume13
Issue number4
DOIs
StatePublished - Apr 1 2015

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Barrett Esophagus
Adenocarcinoma
Mortality
Confidence Intervals
Survival
Proportional Hazards Models
Neoplasms
Demography

Keywords

  • Endoscopic Therapy
  • Esophageal Cancer
  • Prognostic Factor
  • Tumor Progression

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Clinical and Histologic Determinants of Mortality for Patients With Barrett's Esophagus-Related T1 Esophageal Adenocarcinoma. / Leggett, Cadman; Lewis, Jason T.; Wu, Tsung Teh; Schleck, Cathy D.; Zinsmeister, Alan R.; Dunagan, Kelly T.; Lutzke, Lori S.; Wang, Kenneth Ke Ning; Iyer, Prasad G.

In: Clinical Gastroenterology and Hepatology, Vol. 13, No. 4, 01.04.2015, p. 658-664.

Research output: Contribution to journalArticle

Leggett, Cadman ; Lewis, Jason T. ; Wu, Tsung Teh ; Schleck, Cathy D. ; Zinsmeister, Alan R. ; Dunagan, Kelly T. ; Lutzke, Lori S. ; Wang, Kenneth Ke Ning ; Iyer, Prasad G. / Clinical and Histologic Determinants of Mortality for Patients With Barrett's Esophagus-Related T1 Esophageal Adenocarcinoma. In: Clinical Gastroenterology and Hepatology. 2015 ; Vol. 13, No. 4. pp. 658-664.
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abstract = "Background and Aims: Superficial (T1) esophageal adenocarcinoma (EAC) commonly is treated by endoscopic resection, yet little is known about factors that predict outcomes of this approach. We assessed clinical and histologic variables associated with the overall survival times of patients with T1 EAC who received therapy. Methods: In a retrospective analysis, we collected data from patients who underwent endoscopic mucosal resection (EMR) for T1 EAC (194 patients with T1a and 75 patients with T1b) at the Mayo Clinic, from 1995 through 2011. EMR specimens were reviewed systematically for depth of invasion, presence of lymphovascular invasion, grade of differentiation, and status of resection margins. Kaplan-Meier curves and proportional hazards regression models were used in statistical analyses. Results: Demographic characteristics were similar between patients with T1a and T1b EAC. Overall survival at 5 years after EMR was 74.4{\%} for patients with T1a (95{\%} confidence interval [CI], 67.6{\%}-81.8{\%}) and 53.2{\%} for patients with T1b EAC (95{\%} CI, 40.3{\%}-70.1{\%}). Of surviving patients with T1a EAC, 94.1{\%} remained free of cancer (95{\%} CI, 89.8{\%}-98.5{\%}), and 94.7{\%} of surviving patients with T1b EAC remained free of cancer (95{\%} CI, 85.2{\%}-100{\%}). A multivariable model associated older age (per 10-year increment), evidence of lymphovascular invasion, and deep margin involvement with reduced overall survival in patients with T1 EAC. Conclusions: Systematic assessment of EMR specimens can help predict mortality and potentially guide treatment options for patients with T1 EAC.",
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T1 - Clinical and Histologic Determinants of Mortality for Patients With Barrett's Esophagus-Related T1 Esophageal Adenocarcinoma

AU - Leggett, Cadman

AU - Lewis, Jason T.

AU - Wu, Tsung Teh

AU - Schleck, Cathy D.

AU - Zinsmeister, Alan R.

AU - Dunagan, Kelly T.

AU - Lutzke, Lori S.

AU - Wang, Kenneth Ke Ning

AU - Iyer, Prasad G

PY - 2015/4/1

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N2 - Background and Aims: Superficial (T1) esophageal adenocarcinoma (EAC) commonly is treated by endoscopic resection, yet little is known about factors that predict outcomes of this approach. We assessed clinical and histologic variables associated with the overall survival times of patients with T1 EAC who received therapy. Methods: In a retrospective analysis, we collected data from patients who underwent endoscopic mucosal resection (EMR) for T1 EAC (194 patients with T1a and 75 patients with T1b) at the Mayo Clinic, from 1995 through 2011. EMR specimens were reviewed systematically for depth of invasion, presence of lymphovascular invasion, grade of differentiation, and status of resection margins. Kaplan-Meier curves and proportional hazards regression models were used in statistical analyses. Results: Demographic characteristics were similar between patients with T1a and T1b EAC. Overall survival at 5 years after EMR was 74.4% for patients with T1a (95% confidence interval [CI], 67.6%-81.8%) and 53.2% for patients with T1b EAC (95% CI, 40.3%-70.1%). Of surviving patients with T1a EAC, 94.1% remained free of cancer (95% CI, 89.8%-98.5%), and 94.7% of surviving patients with T1b EAC remained free of cancer (95% CI, 85.2%-100%). A multivariable model associated older age (per 10-year increment), evidence of lymphovascular invasion, and deep margin involvement with reduced overall survival in patients with T1 EAC. Conclusions: Systematic assessment of EMR specimens can help predict mortality and potentially guide treatment options for patients with T1 EAC.

AB - Background and Aims: Superficial (T1) esophageal adenocarcinoma (EAC) commonly is treated by endoscopic resection, yet little is known about factors that predict outcomes of this approach. We assessed clinical and histologic variables associated with the overall survival times of patients with T1 EAC who received therapy. Methods: In a retrospective analysis, we collected data from patients who underwent endoscopic mucosal resection (EMR) for T1 EAC (194 patients with T1a and 75 patients with T1b) at the Mayo Clinic, from 1995 through 2011. EMR specimens were reviewed systematically for depth of invasion, presence of lymphovascular invasion, grade of differentiation, and status of resection margins. Kaplan-Meier curves and proportional hazards regression models were used in statistical analyses. Results: Demographic characteristics were similar between patients with T1a and T1b EAC. Overall survival at 5 years after EMR was 74.4% for patients with T1a (95% confidence interval [CI], 67.6%-81.8%) and 53.2% for patients with T1b EAC (95% CI, 40.3%-70.1%). Of surviving patients with T1a EAC, 94.1% remained free of cancer (95% CI, 89.8%-98.5%), and 94.7% of surviving patients with T1b EAC remained free of cancer (95% CI, 85.2%-100%). A multivariable model associated older age (per 10-year increment), evidence of lymphovascular invasion, and deep margin involvement with reduced overall survival in patients with T1 EAC. Conclusions: Systematic assessment of EMR specimens can help predict mortality and potentially guide treatment options for patients with T1 EAC.

KW - Endoscopic Therapy

KW - Esophageal Cancer

KW - Prognostic Factor

KW - Tumor Progression

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