Abstract：
OBJECTIVE: Endoscopic eradication therapy (EET) is guideline endorsed for management of early-stage (T1) esophageal adenocarcinoma (EAC). Patients with baseline high-grade dysplasia (HGD) and EAC are at highest risk of recurrence after successful EET, but limited data exist on long-term (>5 year) recurrence outcomes. Our aim was to assess the incidence and predictors of long-term recurrence in a multicenter cohort of patients with T1 EAC treated with EET.
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.
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.
摘要：
目的：内镜根除治疗（EET）是早期（T1）食管腺癌（EAC）治疗的指南。基线高度异型增生（HGD）和EAC患者在EET成功后复发的风险最高。但关于长期(>5年)复发结局的数据有限.我们的目的是评估接受EET治疗的T1EAC患者的多中心队列中长期复发的发生率和预测因素。
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。
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。
