title: Endoscopic ultrasonography in esophageal cancer leads to improved survival rates: results from a population-based study.
abstract: BACKGROUND
  The advantages of endoscopic ultrasound (EUS) and computed tomography (CT)-positron emission tomography (PET) with respect to survival for esophageal cancer patients are unclear. This study aimed to assess the effects of EUS, CT-PET, and their combination on overall survival with respect to cases not receiving these procedures.
  
  
  METHODS
  Patients who were ≥66 years old when diagnosed with esophageal cancer were identified in the Surveillance, Epidemiology, and End Results-Medicare linked database. Cases were split into 4 analytic groups: EUS only (n = 318), CT-PET only (n = 853), EUS+CT-PET (n = 189), and no EUS or CT-PET (n = 2439). Survival times were estimated with the Kaplan-Meier method and were compared with the log-rank test for each group versus the no EUS or CT-PET group. Multivariate Cox proportional hazards models were used to compare 1-, 3-, and 5-year survival rates.
  
  
  RESULTS
  Kaplan-Meier analyses showed that EUS, CT-PET, and EUS+CT-PET patients had improved survival for all stages (with the exception of stage 0 disease) in comparison with patients undergoing no EUS or CT-PET. Receipt of EUS increased the likelihood of receiving endoscopic therapies, esophagectomy, and chemoradiation. Multivariate Cox proportional hazards models showed that receipt of EUS was a significant predictor of improved 1- (hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.39-0.59; P < .0001), 3- (HR, 0.57; 95% CI, 0.48-0.66; P < .0001), and 5-year survival (HR, 0.59; 95% CI, 0.50-0.68). Similar results were noted when the results were stratified on the basis of histology and for the CT-PET and EUS+CT-PET groups.
  
  
  CONCLUSIONS
  Receipt of either EUS or CT-PET alone in esophageal cancer patients was associated with improved 1-, 3-, and 5-year survival. Future studies should identify barriers to the dissemination of these staging modalities.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado; Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Denver, Colorado.
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
authors.forename: Ananya
authors.initials: A
authors.lastname: Das
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.forename: Jennifer
authors.initials: J
authors.lastname: Drahos
authors.forename: Winifred
authors.initials: W
authors.lastname: Ricker
authors.forename: Ruth
authors.initials: R
authors.lastname: Parsons
authors.forename: Ajay
authors.initials: A
authors.lastname: Bansal
authors.forename: Roy
authors.initials: R
authors.lastname: Yen
authors.forename: Lindsay
authors.initials: L
authors.lastname: Hosford
authors.forename: Meghan
authors.initials: M
authors.lastname: Jankowski
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
authors.forename: Michael B
authors.initials: MB
authors.lastname: Cook
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000401:mortality; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000401:mortality; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D006278:Medicare; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D016016:Proportional Hazards Models; D018426:SEER Program; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology
keywords: endoscopic ultrasonography; endoscopic ultrasound; esophageal cancer; positron emission tomography and computed tomography; staging; survival