Esophageal cancer: Endoscopic therapy bests esophagectomy
In late stage I esophageal cancer, endoscopic therapy correlated with better improvements in cancer-specific survival compared with esophagectomy, according to results published in Gastrointestinal Endoscopy
“This advantage was more pronounced for patients treated after 2009, potentially because of increasing clinician expertise in performing ET and patient selection,” Justin C. McCarty, DO, MPH, from Harvard School of Public Health in Boston, and colleagues wrote.
Researchers used the Surveillance, Epidemiology and End Results (SEER) database to perform a retrospective cohort study of 2,133 patients with node-negative, superficial esophageal cancer who received treatment with endoscopic therapy (n = 772) or esophagectomy (n = 1,361). Investigators compared cancer-specific survival with competing-risk models and evaluated overall survival with Cox proportional hazards models. They also compared time periods 2004 to 2009 and 2010 to 2015 with subgroup analysis.
The unadjusted 5-year survival for cancer-specific death for ET was 87.7% vs. 82.4% for esophagectomy (P = .002), according to study data. Cancer-specific survival was greater in patients treated with ET compared with esophagectomy within the adjusted competing-risk model (sub-distribution hazard ratio [sHR] = 1.92; 95% CI, 1.35-2.74). The sHR for esophagectomy was 1.68 (95% CI, 1.07-2.66) between 2004 to 2009; however, the sHR for esophagectomy was 2.02 (95% CI, 1.08-3.76) between 2010 to 2015.
“Our results do not have sufficient power to determine a difference in this subgroup,” the researchers wrote. “However, on subgroup analysis of patients without missing data on tumor depth, the cancer-specific and overall survival benefit of ET persisted for patients with T1a and T1b tumors. Directly extrapolating the findings of this study to change treatment paradigms for other patients is not appropriate, but it is important to understand how current treatment strategies for stage I esophageal cancer using ET are improving survival.”