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


METHODS
Population-based study.


METHODS
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.


METHODS
EET and esophagectomy.


METHODS
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.


CONCLUSIONS
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.
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.
Sachin
S
Wani
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
Jennifer
J
Drahos
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
Michael B
MB
Cook
University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, Missouri, USA.
Amit
A
Rastogi
University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, Missouri, USA.
Ajay
A
Bansal
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.
Roy
R
Yen
University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, Missouri, USA.
Prateek
P
Sharma
Arizona Center for Digestive Health, Gilbert, Arizona, USA.
Ananya
A
Das
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
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