Metastasis Rate High After Resection of High-Risk Esophageal Cancers

NEW YORK (Reuters Health) – The annual metastasis rate after radical endoscopic resection of high-risk intramucosal esophageal adenocarcinoma is nearly 7%, indicating a need for close follow-up, a retrospective study suggests.

In a review of data on 1,569 patients who underwent endoscopic resection of esophageal cancer in The Netherlands between 2008 and 2019, researchers identified 120 individuals with histopathologic risk factors for lymph node metastasis who underwent endoscopic follow up.

They stratified these individuals into three groups: high-risk T1a, i.e., lesions with poor tumor grade (G3) or lymphovascular invasion; low-risk T1b, i.e., submucosal cancer with superficial invasion in the submucosa, well to moderately differentiated (G1-G2) and no lymphovascular invasion; and high-risk T1b, i.e., submucosal tumors with deep invasion, poor differentiation grade, or lymphovascular invasion.

Overall, during a median follow-up of 29 months (IQR 15-48), nine patients (7.5%) were diagnosed with metastatic disease, corresponding to an annual risk of 2.7%. The five patients with distant metastases died. Four had lymph node metastases and were treated with a curative intent; two died of complications of the treatment.

Metastases were observed in five of the 25 high-risk patients (20%; annual risk 6.9%), one of 55 patients in the low-risk group (annual risk, 0.7%); and three of 40 patients in the intermediate-risk group (annual risk 3.0%), according to a report in Gastrointestinal Endoscopy by Dr. Esther Nieuwenhuis of Amsterdam University Medical Centers and colleagues.

Median times to metastasis were 31 months, 22 months, and 24 months in the high-, low-, and intermediate-risk groups, respectively.

The non-cancer-related mortality rate was 13%, with these deaths occurring at median 34 months after baseline. The authors note that subjects in this retrospective study were more likely to be frail patients with comorbidities who were offered endoscopic resection rather than surgery, creating a possible selection bias.

They also note that their population is highly selected, with negative deep margins, and without metastatic disease at baseline.

“Whereas the annual metastasis rate for high-risk submucosal esophageal adenocarcinoma (3.0%) was somewhat lower than expected in comparison with previous reported percentages, the annual metastasis rate of 6.9% for high-risk intramucosal esophageal adenocarcinoma is new and worrisome,” the researchers conclude. “This calls for further prospective studies and suggests that strict follow-up of this small subgroup is warranted until prospective data are available.”

SOURCE: https://bit.ly/3qrQKI2 Gastrointestinal Endoscopy, online March 11, 2022.

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