Outcomes of submucosal (T1b) esophageal adenocarcinomas removed by endoscopic mucosal resection

Table 1 Characteristics of T1b esophageal adenocarcinoma by treatment modality following endoscopic mucosal resection

	Group A (n = 16)	Group B (n = 9)	Group C (n = 7)	Group D (n = 21)	Overall (n = 53)
Average age, yr	75 ± 78	70 ± 14	62 ± 5	72 ± 13	71 ± 12
Median follow-up after EMR, mo (range)	34 (12-102)	27 (12-56)	49 (13-103)	N/A	34 (12-103) (for groups A-C, n = 32)
EMR method, n (%)
Cap	6 (38)	0 (0)	2 (29)	4 (19)	12 (23)
Band	10 (62)	9 (100)	5 (71)	17 (81)	41 (77)
Pathology depth, n (%)
sm1	6 (38)	4 (44)	1 (14)	2 (10)	13 (25)
sm2/3	10 (62)	5 (56)	6 (86)	19 (90)	40 (75)
Tumor location, n (%)
Proximal two-thirds	2 (13)	1 (11)	1 (14)	5 (24)	9 (17)
Distal one-third	14 (88)	8 (89)	6 (86)	16 (76)	44 (83)
LPI, n (%)
Yes	1 (6)	1 (11)	0 (0)	3 (14)	5 (9)
No	15 (94)	8 (89)	7 (100)	18 (86)	48 (91)
Differentiation, n (%)
Well-moderate	14 (88)	6 (67)	7 (100)	15 (71)	42 (79)
Poor	2 (13)	3 (33)	0 (0)	6 (29)	11 (21)
EMR margins for cancer, n (%)
Deep -/lateral -	6 (38)	2 (22)	1 (14)	2 (10)	11 (21)
Deep -/lateral +	5 (31)	1 (11)	1 (14)	4 (19)	11 (21)
Deep +/lateral +	4 (25)	6 (66)	5 (71)	13 (62)	28 (53)
Deep +/lateral -	1 (6)	0 (0)	0 (0)	2 (10)	3 (6)
Recurrences, n (%)
Yes	6 (38)	1 (11)	2 (29)	N/A	9 (28)
No	10 (63)	8 (88)	5 (71)		23 (72)
Median time to recurrence (mo, range)	21 (6-73)	30 (30-30)	21 (7-35)		21 (6-73) (for groups A-C, n = 32)
Location of recurrence
Local	5	0	1	N/A	6
Metastatic	1	1	1		3

EMR: Endoscopic mucosal resection; LPI: Lymphatic/perineural invasion.

Table 2 Recurrence rates of esophageal adenocarcinoma by investigated risk factors of esophageal adenocarcinoma (n = 32) n (%)

Variable	Recurrence rates	P value
EMR method
Cap	4/8 (50)	0.18
Band	5/24 (21)
Pathology depth
sm1	3/11 (27)	0.11
sm2/3	6/21 (29)
Tumor location
Proximal 2/3 esophagus	2/4 (50)	0.56
Distal 1/3 esophagus	7/28 (25)
LPI
Yes	0/2 (0)	1.00
No	9/30 (30)
Differentiation
Well-moderate	8/27 (30)	1.00
Poor	1/5 (20)
Deep EMR margins
Positive	4/16 (25)	1.00
Negative	5/16 (31)
Lateral EMR margins
Positive	6/22 (27)	1.00
Negative	3/10 (30)
Primary treatment
Endoscopic +/- CRT	7/25 (28)	1.00
Surgical	2/7 (29)

EMR: Endoscopic mucosal resection; LPI: Lymphatic/perineural invasion; CRT: Chemoradiation.

Table 3 Endoscopic ultrasound staging/path accuracy for T1b esophageal adenocarcinoma

EUS staging (n = 51)	Pathologic staging
	pT1sm1 (n = 12)	pT1sm2/3 (n = 39)	Overall (all pT1b) (n = 51)
uT0 Nx	0	1	1
uT1 Nx	11	36	47
uT2 Nx	1	2	3
T staging accuracy	91.7%	92.3%	92.2%

Table 4 Studies evaluating endoscopic management of T1b esophageal adenocarcinoma

Ref.	# Patients	Depth of invasion	Histology	Margins	Remission	Recurrence	Survival
Manner et al[12]	21	sm1	Well to moderately differentiated, no lymphovascular invasion	Lateral margins negative in 12	95% at mean 5.3 mo	28% at mean 62 mo (range 45-89)	67% estimated 5-yr survival
Alvarez Herrero et al[14]	18	sm1 and sm2/3	Well, moderately and poorly differentiated, some with lymphovascular invasion	Not reported	Not reported	17%	Not reported
Tian et al[15]	29	sm1 and sm2-3	Not reported	Not reported	Not reported	Not reported	62% with median duration 34.8 mo
Manner et al[13]	66	sm1	Well to moderately differentiated, no lymphovascular invasion	Not reported	84% at mean 4.5 mo	21% at mean 22 mo (range 6-60)	84% estimated 5-yr survival