A retrospective cohort study of endoscopic therapy and esophagectomy for stage 1 esophageal cancer: less is more
| Autor: | Prasad G. Iyer, Robert K. Parker, Justin C. McCarty, Roberto J. Vidri, Stuart R. Lipsitz, Kortney A. Robinson, Sidhu P. Gangadharan |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
education.field_of_study Proportional hazards model business.industry medicine.medical_treatment Population Gastroenterology Retrospective cohort study Subgroup analysis Esophageal cancer medicine.disease Confidence interval 03 medical and health sciences 0302 clinical medicine Esophagectomy 030220 oncology & carcinogenesis Internal medicine medicine 030211 gastroenterology & hepatology Radiology Nuclear Medicine and imaging Stage (cooking) education business |
| Zdroj: | Gastrointestinal Endoscopy. 92:23-30 |
| ISSN: | 0016-5107 |
| DOI: | 10.1016/j.gie.2020.01.012 |
| Popis: | Background and Aims Current guidelines recommend consideration of endoscopic therapy (ET) when treating select stage I esophageal cancers. The proportion of esophageal cancers treated with ET compared with esophagectomy has increased over time. Overall and cancer-specific survival have not been shown to be superior with ET in prior population-based studies. We thus evaluated cancer-specific survival comparing patients treated with ET and esophagectomy. Methods We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results database from 2004 to 2015 of patients with node-negative, superficial (T1a/T1b), esophageal cancer treated with ET or esophagectomy. Competing-risks models were used to compare cancer-specific survival. Cox proportional hazards models were used to assess overall survival. Subgroup analysis was performed comparing time periods 2004 to 2009 and 2010 to 2015. Results Of 2133 included individuals, 772 (36.2%) underwent ET and 1361 (63.8%) underwent esophagectomy. Unadjusted 5-year survival for cancer-specific death was 87.7% (95% confidence interval [CI], 84.2-90.5) for ET and 82.4% (95% CI, 80.0- 84.5) for esophagectomy (P = .002). Within the adjusted competing-risk model, cancer-specific survival was superior in patients treated with ET compared with esophagectomy (subdistribution hazard ratio [SHR], 1.92; 95% CI, 1.35-2.74; P Conclusions ET was associated with improved cancer-specific survival compared with esophagectomy in stage I esophageal cancer. This advantage was more pronounced for patients treated after 2009, potentially because of increasing clinician expertise in performing ET and patient selection. |
| Databáze: | OpenAIRE |
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