Faculty Collaboration Database

Predictors Of Treatment Failure After Radiofrequency Ablation For Intramucosal Adenocarcinoma in Barrett Esophagus: A Multi-institutional Retrospective Cohort Study. Am J Surg Pathol 2016 Apr;40(4):554-62

Date

12/10/2015

Pubmed ID

26645729

DOI

10.1097/PAS.0000000000000566

Scopus ID

2-s2.0-84949446182 (requires institutional sign-in at Scopus site)   16 Citations

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.

Author List

Agoston AT, Strauss AC, Dulai PS, Hagen CE, Muzikansky A, Fudman DI, Abrams JA, Forcione DG, Jajoo K, Saltzman JR, Odze RD, Lauwers GY, Gordon SR, Lightdale CJ, Rothstein RI, Srivastava A

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Adult
Aged
Barrett Esophagus
Carcinoma in Situ
Catheter Ablation
Cohort Studies
Esophageal Neoplasms
Esophagoscopy
Female
Humans
Male
Middle Aged
Mucous Membrane
Proportional Hazards Models
Retrospective Studies
Risk Factors
Treatment Outcome