High- vs low-risk T1a EAC tied to more extraesophageal metastases

Patients with high-risk T1a esophageal adenocarcinoma (EAC) undergoing successful endoscopic eradication therapy (EET) appear to have a greater rate of extraesophageal metastases than those with low-risk T1a EAC on long-term follow-up, reports a study.

Investigators included 180 patients who underwent EET for T1a EAC at three referral Barrett’s esophagus endotherapy units between 1996 and 2022. Those with submucosal invasion, positive deep margins, or metastases at initial diagnosis were excluded.

High-risk T1a EAC was characterized by T1a EAC with poor differentiation or lymphovascular invasion, and low-risk disease by the absence of such features. Expert gastrointestinal pathologists assessed all pathology. The investigators abstracted baseline and follow-up endoscopy and pathology data, then performed time-to-event analyses to compare outcomes between groups.

Of the patients (median age 70 years, 84 percent men), 45 had high-risk and 143 had low-risk T1a EAC. The two groups had comparable age, sex, Barrett’s esophagus length, lesion size, and EET technique.

Patients with high-risk T1a EAC showed significantly higher rates of delayed extraesophageal metastases (11.1 percent vs 1.4 percent; p=0.02). On the other hand, the rates of intraluminal EAC recurrence (p=0.79) and overall survival (p=0.73) did not differ significantly between the two groups.

“These data should be factored into discussions with patients while selecting treatment approaches,” the investigators said. “Additional prospective data in this area are critical.”

EET is the standard of care for patients with T1a EAC.