Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
Endoscopy. 2022 Feb;54(2):163-169. doi: 10.1055/a-1380-8899. Epub 2021 Apr 4.
Clinical tumor stage of esophageal adenocarcinoma (EAC) is determined by endoscopic ultrasound and/or computed tomography scan, which have low accuracy for stages T1 and T2, potentially leading to overtreatment. We aimed to assess the proportion of cT2 EACs downstaged to cT1 after endoscopic reassessment (ERA) by an experienced interventional endoscopist. METHODS : We performed a prospective multicenter cohort study. Patients with cT2N0M0 EAC were included and underwent ERA. The primary outcome was proportion of cT2 EACs downstaged to cT1 after ERA. RESULTS : 15/25 included patients (60 %) were downstaged from cT2 to cT1 EAC after ERA and underwent attempted endoscopic resection. Endoscopic resection was aborted in 3/15 patients because of tumor invasion into the muscle layer; all three underwent successful surgical resection. Endoscopic resection was successful in 12/15 patients (80 %), all of whom had pT1 tumors. Overall, 10/25 (40 %) were treated with endoscopic resection alone. CONCLUSIONS : ERA downstaged about half of the cT2 tumors to cT1, rendering them suitable for endoscopic resection. ERA had substantial clinical impact on therapeutic management, preventing overtreatment in 40 % of patients.
食管腺癌（EAC）的临床肿瘤分期由内镜超声和/或计算机断层扫描确定，但对于 T1 和 T2 期，其准确性较低，可能导致过度治疗。我们旨在评估经验丰富的介入内镜医生进行内镜重新评估（ERA）后 cT2 EAC 降期为 cT1 的比例。
我们进行了一项前瞻性多中心队列研究。纳入 cT2N0M0 EAC 患者，并进行 ERA。主要结局是 ERA 后 cT2 EAC 降期为 cT1 的比例。
15/25 例纳入患者（60%）在 ERA 后从 cT2 降期为 cT1 EAC，并尝试行内镜下切除。由于肿瘤侵犯肌层，3/15 例患者中止内镜下切除；这 3 例患者均成功接受了手术切除。12/15 例（80%）患者的内镜下切除成功，所有患者均为 pT1 肿瘤。总的来说，10/25 例（40%）患者仅接受内镜下切除治疗。
ERA 将约一半的 cT2 肿瘤降期为 cT1，使它们适合行内镜下切除。ERA 对治疗管理具有重要的临床影响，使 40%的患者避免了过度治疗。
