title: Treatment modalities for T1N0 esophageal cancers: a comparative analysis of local therapy versus surgical resection.
abstract: BACKGROUND
  To investigate the role of nonsurgical treatment for early-stage esophageal cancer, we compared the outcomes of local therapy to esophagectomy, using a large, national database.
  
  
  METHODS
  Five-year cancer-specific and overall survival (OS) of patients, with T1N0M0 squamous cell or adenocarcinoma of the mid or distal esophagus treated with either surgery or local therapy, with ablative and/or excision techniques, in the Surveillance Epidemiology and End Results cancer registry from 1998 to 2008, were compared using the Kaplan-Meier approach, and multivariable and propensity-score adjusted Cox proportional hazard, and competing risk models.
  
  
  RESULTS
  Of 1458 patients with T1N0 esophageal cancer, 1204 (83%) had surgery and 254 (17%) had local therapy only. The use of local therapy increased significantly from 8.1% in 1998 to 24.1% in 2008 (p < 0.001). The 5-year OS after local excisional therapy and surgery was not significantly different (55.5% versus 64.1% respectively, p = 0.07), and 5-year cancer-specific survival (CSS) also did not differ (81.7% versus 75.8%, p = 0.10). However, after propensity-score adjustment, CSS was better for patients who underwent local therapy compared with those who underwent surgery (hazard ratio: 0.46, 95% confidence interval: 0.27-0.77, p = 0.003), whereas OS remained similar.
  
  
  CONCLUSIONS
  The use of local therapy for T1N0 esophageal cancers increased significantly from 1998 to 2008. Compared with those treated with esophagectomy, patients treated with local therapy had similar OS but improved CSS, indicating a higher chance of dying from other causes. Further studies are needed to confirm the oncologic efficacy of local therapy when used in patients whose lifespans are not limited by conditions other than esophageal cancer.
authors.affiliation: *Department of Surgery, Duke University Medical Center, Durham, North Carolina; †Department of Visceral Surgery and Medicine, University of Bern, ‡Institute of Forensic Medicine, University of Bern, Inselspital, Bern, Switzerland; §Department of Surgery, University of Kentucky, Lexington, Kentucky.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Berry
authors.forename: Josiane
authors.initials: J
authors.lastname: Zeyer-Brunner
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Castleberry
authors.forename: Jeremiah T
authors.initials: JT
authors.lastname: Martin
authors.forename: Beat
authors.initials: B
authors.lastname: Gloor
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.forename: Mathias
authors.initials: M
authors.lastname: Worni
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology; D011379:Prognosis; D011878:Radiotherapy; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate