Predictors for Lymph Node Metastasis and Survival of Patients with T1b Esophageal Adenocarcinoma Treated with Surgery and Endoscopic Therapy: An Analysis of Surveillance, Epidemiology, and End Results Database

Sonmoon Mohapatra; Sarah S Al Ghamdi; Paris Charilaou; Chawin Lopimpisuth; Amit Das; Saowanee Ngamruengphong

doi:10.1016/j.gie.2024.05.005

Predictors for Lymph Node Metastasis and Survival of Patients with T1b Esophageal Adenocarcinoma Treated with Surgery and Endoscopic Therapy: An Analysis of Surveillance, Epidemiology, and End Results Database

Gastrointest Endosc. 2024 May 9:S0016-5107(24)03190-0. doi: 10.1016/j.gie.2024.05.005. Online ahead of print.

Authors

Sonmoon Mohapatra¹, Sarah S Al Ghamdi², Paris Charilaou³, Chawin Lopimpisuth⁴, Amit Das⁵, Saowanee Ngamruengphong⁶

Affiliations

¹ Department of Gastroenterology and Hepatology, Mayo Clinic, Arizona, USA, 85054. Electronic address: sonmoon0mohapatra@gmail.com.
² Department of Gastroenterology and Hepatology, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. Electronic address: ssalghamdi3@kau.edu.sa.
³ Department of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill-Cornell Medical College, New York, USA, 10065. Electronic address: pa9188@med.cornell.edu.
⁴ Department of Gastroenterology and Hepatology, Johns Hopkins University, MD, United States, 21287. Electronic address: chawin.lopimpisuth@gmail.com.
⁵ Department of Computer Science, Dartmouth college, New Hampshire, United States, 03755. Electronic address: amit.das.25@dartmouth.edu.
⁶ Department of Gastroenterology and Hepatology, Johns Hopkins University, MD, United States, 21287. Electronic address: sngamru1@jhmi.edu.

PMID: 38734257
DOI: 10.1016/j.gie.2024.05.005

Abstract

Background and aims: Limited data exists regarding the long-term outcomes of endoscopic therapy (ET) with or without chemoradiation therapy (CRT) for T1b esophageal adenocarcinoma (EAC). Our aim was to identify the risk factors for lymph node metastasis (LNM) in T1b EAC and assess how the chosen treatment modality affects overall survival (OS) and cancer-specific survival (CSS).

Methods: We analyzed histologically confirmed T1b EAC patients diagnosed between 2004 and 2018 using Surveillance Epidemiology and End Results database. Focusing on T1bN0M0 staging, we divided the patients into two groups: ET (n=174) and surgery (n=769), and calculated OS and CSS rates.

Results: Out of 1418 patients with T1b EAC, 228 cases (16.1%) exhibited LNM at diagnosis. Notable risk factors for LNM included poorly differentiated tumor and lesion size ≥20 mm. For T1bN0M0 cases, ET was commonly performed from 2009 to 2018 (OR 4.3), especially for patients aged ≥ 65 years (OR 3.1) with tumor size <20mm (OR 2.3). During 50 months median follow-up, age ≥ 65 years (HR 1.9), ET (HR 1.5), and CRT (HR 1.4) were associated with poorer OS. Factors linked to decreased CSS were age ≥ 65 years (sub hazard ratio (SHR) 1.6), poorly differentiated tumors (SHR 1.5), and CRT (SHR 1.5).

Conclusion: In T1b EAC, tumor size ≥20mm and poor differentiation are notable risk factors for LNM. ET showed comparable CSS outcomes to surgery for carefully selected T1bN0M0 lesions. CRT did not provide additional survival benefit for these lesions; however, large scale studies are required to validate this finding.

Keywords: Endoscopic therapy; Esophageal adenocarcinoma; Surveillance, Epidemiology, and End Results Program.