TY - JOUR
T1 - Predictors of treatment failure after radiofrequency ablation for intramucosal adenocarcinoma in barrett esophagus
T2 - A multi-institutional retrospective cohort study
AU - Agoston, Agoston T.
AU - Strauss, Adam C.
AU - Dulai, Parambir S.
AU - Hagen, Catherine E.
AU - Muzikansky, Alona
AU - Fudman, David I.
AU - Abrams, Julian A.
AU - Forcione, David G.
AU - Jajoo, Kunal
AU - Saltzman, John R.
AU - Odze, Robert D.
AU - Lauwers, Gregory Y.
AU - Gordon, Stuart R.
AU - Lightdale, Charles J.
AU - Rothstein, Richard I.
AU - Srivastava, Amitabh
N1 - Publisher Copyright:
© 2015 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016
Y1 - 2016
N2 - 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 Z50% 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.
AB - 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 Z50% 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.
KW - Barrett esophagus
KW - Endoscopic mucosal resection
KW - Intramucosal adenocarcinoma
KW - Radiofrequency ablation
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U2 - 10.1097/PAS.0000000000000566
DO - 10.1097/PAS.0000000000000566
M3 - Article
C2 - 26645729
AN - SCOPUS:84949446182
SN - 0147-5185
VL - 40
SP - 554
EP - 562
JO - American Journal of Surgical Pathology
JF - American Journal of Surgical Pathology
IS - 4
ER -