METHODS: Patients with T1 EAC achieving successful endoscopic cancer eradication with a minimum of 5 years\' clinical follow-up were included. The primary outcome was neoplastic recurrence, defined as dysplasia or EAC, and it was characterized as early (<2 years), intermediate (2-5 years), or late (>5 years). Predictors of recurrence were assessed by time to event analysis.
RESULTS: A total of 84 T1 EAC patients (75 T1a, 9 T1b) with a median 9.1 years (range, 5.1-18.3 years) of follow-up were included. The overall incidence of neoplastic recurrence was 2.0 per 100 person-years of follow-up. Seven recurrences (3 dysplasia, 4 EAC) occurred after 5 years of EAC remission. Overall, 88% of recurrences were treated successfully endoscopically. EAC recurrence-related mortality occurred in 3 patients at a median of 5.2 years from EAC remission. Complete eradication of intestinal metaplasia was independently associated with reduced recurrence (hazard ratio, .13).
CONCLUSIONS: Following successful EET of T1 EAC, neoplastic recurrence occurred after 5 years in 8.3% of cases. Careful long-term surveillance should be continued in this patient population. Complete eradication of intestinal metaplasia should be the therapeutic end point for EET.
方法:T1EAC患者在至少5年的临床随访时间内成功根除肿瘤。主要结果是肿瘤复发,定义为发育不良或EAC,它的特点是早期(<2年),中级(2-5年),或迟到(>5年)。通过事件发生时间分析评估复发的预测因素。
结果:共有84例T1EAC患者(75T1a,9T1b),中位数为9.1年(范围,包括5.1-18.3年)的随访。肿瘤复发的总发生率为2.0/100人-年随访。7次复发(3次发育不良,4EAC)发生在EAC缓解5年后。总的来说,88%的复发通过内窥镜成功治疗。EAC复发相关死亡发生在3例患者中,平均EAC缓解时间为5.2年。完全根除肠上皮化生与减少复发独立相关(风险比,.13)。
结论:在T1EAC成功EET之后,8.3%的病例在5年后发生肿瘤复发。应继续对该患者人群进行仔细的长期监测。完全根除肠上皮化生应该是EET的治疗终点。