title: Predictors Of Treatment Failure After Radiofrequency Ablation For Intramucosal Adenocarcinoma in Barrett Esophagus: A Multi-institutional Retrospective Cohort Study.
abstract: Radiofrequency ablation (RFA), with or without endoscopic mucosal resection (EMR), is a safe, effective, and durable treatment option for Barrett esophagus (BE)-associated dysplasia (DYS), but few studies have identified predictors of treatment failure in BE-associated intramucosal adenocarcinoma (IMC). The aim of this study was to determine the rate of IMC eradication when using RFA±EMR and to identify clinical and pathologic predictors of treatment failure. A retrospective review of medical records and a central review of index histologic parameters were performed for 78 patients who underwent RFA±EMR as the primary treatment for biopsy-proven IMC at 4 academic tertiary medical centers. Complete eradication (CE) (absence of IMC/DYS on first follow-up endoscopy) was achieved in 86% of patients, and durable eradication (DE) (CE with no recurrence of IMC/DYS until last follow-up) was achieved in 78% of patients, with significant variation between the 4 study sites (P=0.03 and 0.09 by analysis of variance for DE and CE, respectively). Use of EMR before RFA significantly reduced the risk for treatment failure for IMC/DYS (hazard ratio, 0.15; 95% confidence interval, 0.05-0.48; P=0.001), whereas IMC involving ≥50% of the columnar metaplastic area on index examination significantly increased the risk for treatment failure (hazard ratio, 4.24; 95% confidence interval, 1.53-11.7; P=0.005). Endoscopic and pathologic factors associated with treatment failure in BE-associated IMC treated with RFA±EMR may help identify the subset of IMC patients for whom a more aggressive initial approach may be justified.
authors.affiliation: *Department of Pathology ¶Harvard Medical School, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA †Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH ∥Columbia University Medical Center, Division of Digestive & Liver Diseases, New York, NY ‡Department of Pathology §Biostatistics Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA.
authors.forename: Agoston T
authors.initials: AT
authors.lastname: Agoston
authors.forename: Adam C
authors.initials: AC
authors.lastname: Strauss
authors.forename: Parambir S
authors.initials: PS
authors.lastname: Dulai
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Hagen
authors.forename: Alona
authors.initials: A
authors.lastname: Muzikansky
authors.forename: David I
authors.initials: DI
authors.lastname: Fudman
authors.forename: Julian A
authors.initials: JA
authors.lastname: Abrams
authors.forename: David G
authors.initials: DG
authors.lastname: Forcione
authors.forename: Kunal
authors.initials: K
authors.lastname: Jajoo
authors.forename: John R
authors.initials: JR
authors.lastname: Saltzman
authors.forename: Robert D
authors.initials: RD
authors.lastname: Odze
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: Lauwers
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Gordon
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Lightdale
authors.forename: Richard I
authors.initials: RI
authors.lastname: Rothstein
authors.forename: Amitabh
authors.initials: A
authors.lastname: Srivastava
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000601:surgery*; D002278:Carcinoma in Situ / Q000601:surgery; D017115:Catheter Ablation; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome