Endoscopic and surgical treatment of superficial esophageal adenocarcinoma yield similar patient outcomes
Multiple studies have provided data showing that endoscopic therapy is associated with fewer complications than is esophagectomy in the treatment of patients with superficial esophageal adenocarcinoma (EAC). However, a lack of population-based studies has made it difficult to compare long-term patient outcomes associated with endoscopic therapy and surgery.
To explore this issue, researchers at Mayo Clinic's campus in Florida turned to the National Cancer Institute Surveillance, Epidemiology and End Results (SEER) database. They identified 1,618 patients with Tis (high-grade dysplasia), T1a (invades lamina propria or muscularis mucosae), or T1b (invades submucosa) esophageal cancer treated from 1998 to 2009.
Patients were divided into two groups:
- Those who received endoscopic therapy (n = 306)
- Those who received surgery (n = 1,312)
Mayo researchers then identified factors associated with endoscopic therapy using multivariate logistic regression, collected survival data through the end of 2009, and compared overall survival and esophageal cancer-specific survival after controlling for relevant covariates.
Published in the November 2013 issue of Clinical Gastroenterology and Hepatology, the Mayo study showed that the use of endoscopic therapy increased progressively from 3 percent in 1998 to 29 percent in 2009. Factors associated with the use of endoscopic therapy included age older than 65 years, diagnosis in 2006 to 2009 versus 1998 to 2001, and the absence of submucosal invasion.
After adjusting for patient and tumor factors, Mayo researchers concluded that long-term survival of patients with EAC did not appear to differ between those who received endoscopic therapy and those treated with surgery. Patients treated endoscopically had similar overall survival times (hazard ratio, 1.21; 95 percent confidence interval, 0.92-1.58) and esophageal cancer-specific survival times (hazard ratio, 0.74; 95 percent confidence interval, 0.49-1.11).
"Our study on national outcomes, as well as our own experience with the procedure at Mayo Clinic, suggests that endoscopic therapy and surgery offer similar chances for cure and long-term survival," says lead author, Michael B. Wallace, M.D., a gastroenterologist at Mayo Clinic's campus in Florida. "These data reinforce the idea that endoscopic therapy is becoming an acceptable method for all patients with very early esophageal cancer."
For more information
Ngamruengphong S, et al. Survival of patients with superficial esophageal adenocarcinoma after endoscopic treatment vs surgery. Clinical Gastroenterology and Hepatology. 2013;11:1424.
National Cancer Institute. Surveillance, Epidemiology and End Results Program (SEER).