Sachin Wani1, Jennifer Drahos2, Michael B Cook2, Amit Rastogi3, Ajay Bansal3, Roy Yen4, Prateek Sharma3, Ananya Das5. 1. 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. 2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA. 3. University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, Missouri, USA. 4. Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA. 5. Arizona Center for Digestive Health, Gilbert, Arizona, USA.
Abstract
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. DESIGN AND SETTING: Population-based study. PATIENTS: 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. INTERVENTION: EET and esophagectomy. MAIN OUTCOME MEASUREMENTS: 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. LIMITATIONS: 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.
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. DESIGN AND SETTING: Population-based study. PATIENTS: 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. INTERVENTION: EET and esophagectomy. MAIN OUTCOME MEASUREMENTS: 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. EETpatients 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. LIMITATIONS: 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.
Authors: Ganapathy A Prasad; Kenneth K Wang; Navtej S Buttar; Louis-Michel Wongkeesong; Kausilia K Krishnadath; Francis C Nichols; Lori S Lutzke; Lynn S Borkenhagen Journal: Gastroenterology Date: 2007-02-07 Impact factor: 22.682
Authors: Hubert J Stein; Marcus Feith; Bjorn L D M Bruecher; Jorg Naehrig; Mario Sarbia; J Rudiger Siewert Journal: Ann Surg Date: 2005-10 Impact factor: 12.969
Authors: Daniel S Oh; Jeffrey A Hagen; Parakrama T Chandrasoma; Christy M Dunst; Steven R Demeester; Mohammad Alavi; Cedric G Bremner; John Lipham; Christian Rizzetto; Richard Cote; Tom R Demeester Journal: J Am Coll Surg Date: 2006-06-22 Impact factor: 6.113
Authors: Nicholas J Shaheen; Prateek Sharma; Bergein F Overholt; Herbert C Wolfsen; Richard E Sampliner; Kenneth K Wang; Joseph A Galanko; Mary P Bronner; John R Goldblum; Ana E Bennett; Blair A Jobe; Glenn M Eisen; M Brian Fennerty; John G Hunter; David E Fleischer; Virender K Sharma; Robert H Hawes; Brenda J Hoffman; Richard I Rothstein; Stuart R Gordon; Hiroshi Mashimo; Kenneth J Chang; V Raman Muthusamy; Steven A Edmundowicz; Stuart J Spechler; Ali A Siddiqui; Rhonda F Souza; Anthony Infantolino; Gary W Falk; Michael B Kimmey; Ryan D Madanick; Amitabh Chak; Charles J Lightdale Journal: N Engl J Med Date: 2009-05-28 Impact factor: 91.245
Authors: O Pech; A Behrens; A May; L Nachbar; L Gossner; T Rabenstein; H Manner; E Guenter; J Huijsmans; M Vieth; M Stolte; C Ell Journal: Gut Date: 2008-05-06 Impact factor: 23.059
Authors: Ganapathy A Prasad; Tsung Teh Wu; Dennis A Wigle; Navtej S Buttar; Louis-Michel Wongkeesong; Kelly T Dunagan; Lori S Lutzke; Lynn S Borkenhagen; Kenneth K Wang Journal: Gastroenterology Date: 2009-06-12 Impact factor: 22.682
Authors: Jon C Gould; Mark R Wendling; Brant K Oeschlager; Sumeet K Mittal; Srinadh Komanduri; Kyle A Perry; Sean Cleary; Susan Galandiuk; Daniel J Scott; P Marco Fisichella; Nicholas J Shaheen; Kelly R Haisley; John G Hunter Journal: J Gastrointest Surg Date: 2017-02-27 Impact factor: 3.452
Authors: Sachin Wani; V Raman Muthusamy; Nicholas J Shaheen; Rena Yadlapati; Robert Wilson; Julian A Abrams; Jacques Bergman; Amitabh Chak; Kenneth Chang; Ananya Das; John Dumot; Steven A Edmundowicz; Glenn Eisen; Gary W Falk; M Brian Fennerty; Lauren Gerson; Gregory G Ginsberg; David Grande; Matt Hall; Ben Harnke; John Inadomi; Janusz Jankowski; Charles J Lightdale; Jitin Makker; Robert D Odze; Oliver Pech; Richard E Sampliner; Stuart Spechler; George Triadafilopoulos; Michael B Wallace; Kenneth Wang; Irving Waxman; Srinadh Komanduri Journal: Am J Gastroenterol Date: 2017-06-01 Impact factor: 10.864
Authors: Linda C Cummings; Tzuyung Doug Kou; Mark D Schluchter; Amitabh Chak; Gregory S Cooper Journal: Gastrointest Endosc Date: 2016-01-19 Impact factor: 9.427