Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, United States.
Dig Liver Dis. 2013 Dec;45(12):1028-33. doi: 10.1016/j.dld.2013.06.009. Epub 2013 Aug 9.
Endoscopic resection followed by ablative therapy is frequently used to treat esophageal high-grade dysplasia or early esophageal adenocarcinoma.
To study outcomes in patients with high-grade dysplasia compared to those with esophageal adenocarcinoma after endoscopic resection.
Retrospective, observational, descriptive, single-centre study from a prospective database. We extracted data from 116 endoscopic resections. Survival was plotted using Kaplan-Meier curves multivariable Cox-proportional hazard assess for possible predictors of survival post-endoscopic resection was performed.
116 patients (64 esophageal adenocarcinoma, 52 high-grade dysplasia) underwent endoscopic resection from May 2003 to June 2010. Mean age was 71 ± 11 years for high-grade dysplasia and 72 ± 10 years for esophageal adenocarcinoma. Median follow-up was 17 months. Eighty-five patients had negative margins on endoscopic resection. Five-year survivals for high-grade dysplasia and esophageal adenocarcinoma were 86% (range 68-100%) and 78% (59-96%), respectively. Survival was not significantly different between groups (p=0.20). Overall mortality rate was 10.6% (9/85). At multivariable Cox regression increased Barrett's oesophagus length was associated with worse survival (HR 1.18 [1.06-1.33], p=0.0039). Survival was not affected by the pathology before resection: HR 2.4 [95%CI, 0.70-8.4], p=0.16.
Survival in patients with high-grade dysplasia of the oesophagus is similar to those with esophageal adenocarcinoma. Longer Barrett's oesophagus segments are associated with decreased survival.
内镜下切除后结合消融治疗常用于治疗食管高级别异型增生或早期食管腺癌。
研究内镜切除后高级别异型增生患者与食管腺癌患者的结局。
这是一项来自前瞻性数据库的回顾性、观察性、描述性、单中心研究。我们从 116 例内镜切除中提取数据。使用 Kaplan-Meier 曲线绘制生存曲线，对可能影响内镜切除后生存的因素进行多变量 Cox 比例风险评估。
2003 年 5 月至 2010 年 6 月，116 例患者（64 例食管腺癌，52 例高级别异型增生）接受了内镜切除。高级别异型增生组的平均年龄为 71±11 岁，食管腺癌组为 72±10 岁。中位随访时间为 17 个月。85 例患者内镜切除后切缘阴性。高级别异型增生和食管腺癌的 5 年生存率分别为 86%（68%-100%）和 78%（59%-96%），两组间无显著差异（p=0.20）。总的死亡率为 10.6%（9/85）。多变量 Cox 回归分析显示，Barrett 食管长度增加与生存率降低相关（HR 1.18[1.06-1.33]，p=0.0039）。术前病理类型对生存无影响（HR 2.4[95%CI，0.70-8.4]，p=0.16）。
食管高级别异型增生患者的生存情况与食管腺癌患者相似。Barrett 食管段较长与生存率降低相关。
