A comparison of endoscopic treatment and surgery in early esophageal cancer: an analysis of surveillance epidemiology and end results data.
OBJECTIVE
Endoscopic therapy for early esophageal cancer is gaining gradual acceptance in the United States. However, little information is available regarding long-term outcome of endoscopic therapy compared to surgical treatment of early esophageal cancer. We aimed to analyze outcomes in terms of cancer-free survival in patients with early esophageal cancer managed with either endoscopic therapy or surgical resection.


METHODS
The Surveillance Epidemiology and End Results database of the National Cancer Institute was searched to identify all patients who were diagnosed with stage 0 and stage 1 nonsquamous and squamous cell-type esophageal cancer between 1998 and 2003. Data on demographic features, tumor characteristics, types of treatment received (endoscopic vs surgical resection), and esophageal cancer-specific mortality were analyzed.


RESULTS
Data were available for analysis in 742 patients with early esophageal cancer. Only 99 (13.3%) of these underwent endoscopic treatment (group A). The remainder of the patients was managed by surgical resection (group B). In the Cox proportional hazards model, the relative hazard for esophageal cancer-specific mortality in group A was not different from that of group B (relative hazard [RH] 0.89, 95% confidence interval [CI] 0.51-1.56, P= 0.68). The significant predictors of survival were age at diagnosis (RH 1.06, 95% CI 1.03-1.08, P < 0.001) and absence of exposure to radiation therapy (RH 0.32, 95% CI 0.21-0.48, P < 0.001).


CONCLUSIONS
Patients with early esophageal cancer managed with endoscopic therapy have equivalent long-term survival compared to those treated with surgical resection. These are the first population-based data that support the effectiveness of endoscopic therapy for managing these patients.
Division of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA.
Ananya
A
Das
Vandana
V
Singh
David E
DE
Fleischer
Virender K
VK
Sharma
D000368:Aged; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004724:Endoscopy; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D018426:SEER Program; D015996:Survival Rate; D014481:United States / Q000453:epidemiology