Survival in esophageal high-grade dysplasia/adenocarcinoma post endoscopic resection.
BACKGROUND
Endoscopic resection followed by ablative therapy is frequently used to treat esophageal high-grade dysplasia or early esophageal adenocarcinoma.


OBJECTIVE
To study outcomes in patients with high-grade dysplasia compared to those with esophageal adenocarcinoma after endoscopic resection.


METHODS
Retrospective, observational, descriptive, single-centre study from a prospective database. We extracted data from 116 endoscopic resections. Survival was plotted using Kaplan-Meier curves multivariable Cox-proportional hazard assess for possible predictors of survival post-endoscopic resection was performed.


RESULTS
116 patients (64 esophageal adenocarcinoma, 52 high-grade dysplasia) underwent endoscopic resection from May 2003 to June 2010. Mean age was 71 ± 11 years for high-grade dysplasia and 72 ± 10 years for esophageal adenocarcinoma. Median follow-up was 17 months. Eighty-five patients had negative margins on endoscopic resection. Five-year survivals for high-grade dysplasia and esophageal adenocarcinoma were 86% (range 68-100%) and 78% (59-96%), respectively. Survival was not significantly different between groups (p=0.20). Overall mortality rate was 10.6% (9/85). At multivariable Cox regression increased Barrett's oesophagus length was associated with worse survival (HR 1.18 [1.06-1.33], p=0.0039). Survival was not affected by the pathology before resection: HR 2.4 [95%CI, 0.70-8.4], p=0.16.


CONCLUSIONS
Survival in patients with high-grade dysplasia of the oesophagus is similar to those with esophageal adenocarcinoma. Longer Barrett's oesophagus segments are associated with decreased survival.
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, United States.
Bashar J
BJ
Qumseya
Abraham M
AM
Panossian
Cynthia
C
Rizk
David J
DJ
Cangemi
Christianne
C
Wolfsen
Massimo
M
Raimondo
Timothy A
TA
Woodward
Michael B
MB
Wallace
Herbert C
HC
Wolfsen
D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy; D016629:Esophagectomy; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000601:surgery; D018365:Neoplasm, Residual; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate
Barrett oesophagus; Endoscopic resection; Esophageal adenocarcinoma; Longterm survival