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Gastrointest Endosc. 2014 Feb;79(2):224-232.e1. doi: 10.1016/j.gie.2013.08.002. Epub 2013 Sep 20.

Comparison of endoscopic therapies and surgical resection in patients with early esophageal cancer: a population-based study.

Author information

1
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA; Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Denver, Colorado, USA.
2
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
3
University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, Missouri, USA.
4
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.
5
Arizona Center for Digestive Health, Gilbert, Arizona, USA.

Abstract

BACKGROUND:

Outcome data comparing endoscopic eradication therapy (EET) and esophagectomy are limited in patients with early esophageal cancer (EC).

OBJECTIVE:

To compare overall survival and EC-related mortality in patients with early EC treated with EET and esophagectomy.

DESIGN AND SETTING:

Population-based study.

PATIENTS:

Patients with early EC (stages T0 and T1) were identified from the Surveillance, Epidemiology, and End Results database (1998-2009). Demographics, tumor specific data, and survival were compared. Cox proportional hazards regression models were used to evaluate the association between treatment and EC-specific mortality.

INTERVENTION:

EET and esophagectomy.

MAIN OUTCOME MEASUREMENTS:

Mid- (2 years) and long- (5 years) term overall survival and EC-specific mortality, outcomes based on histology and stage, treatment patterns, and predictors of cancer-specific mortality.

RESULTS:

A total of 430 (21%) and 1586 (79%) patients underwent EET and esophagectomy, respectively. There was no difference in the 2-year (EET: 10.5% vs esophagectomy: 12.7%, P = .27).and 5-year (EET: 36.7% vs esophagectomy: 42.8%, P = .16) EC-related mortality rates between the 2 groups. EET patients had higher mortality rates attributed to non-EC causes (5 years: 46.6% vs 20.6%, P < .001). Similar results were noted when comparisons were limited to patients with stage T0 and T1a disease and esophageal adenocarcinoma. There was no difference in EC-specific mortality in the EET compared with the surgery group (hazard ratio 1.4; 95% confidence interval, 0.9-2.03). Variables associated with mortality were older age, year of diagnosis, radiation therapy, higher stage, and esophageal squamous cell carcinoma.

LIMITATIONS:

Comorbidities and recurrence rates were not available.

CONCLUSIONS:

This population-based study demonstrates comparable mid- and long-term EC-related mortality in patients with early EC undergoing EET and surgical resection.

KEYWORDS:

CI; EAC; EC; EET; ESCC; HR; SEER; Surveillance, Epidemiology, and End Results; confidence interval; endoscopic eradication therapy; esophageal adenocarcinoma; esophageal cancer; esophageal squamous cell carcinoma; hazard ratio

PMID:
24060519
PMCID:
PMC4042678
DOI:
10.1016/j.gie.2013.08.002
[Indexed for MEDLINE]
Free PMC Article

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