American College of Gastroenterology Annual Meeting

American College of Gastroenterology Annual Meeting

Source:

Ramai D, et al. Abstract S0344. Presented at: The American College of Gastroenterology Annual Scientific Meeting (Virtual). Oct. 26-28, 2020.

Disclosures: The authors report no relevant financial disclosures
November 05, 2020
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Endoscopic resection can be effective in esophageal adenocarcinoma

Source:

Ramai D, et al. Abstract S0344. Presented at: The American College of Gastroenterology Annual Scientific Meeting (Virtual). Oct. 26-28, 2020.

Disclosures: The authors report no relevant financial disclosures
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Endoscopic resection was associated with similar cancer-specific survival compared with esophagectomy in patients with stage T1b esophageal adenocarcinoma, according to research presented at the ACG Virtual Annual Scientific Meeting.

Daryl Ramai, MD, from The Brooklyn Hospital Center, said esophagectomy has been the standard for the treatment of early esophageal cancer, but it is associated with high mortality and morbidity.

“Early esophageal cancer can be effectively treated with endoscopic therapy, as there is a low risk of lymph node metastasis,” he said. “Most studies have reported outcomes of endoscopic therapy for treating T1a lesions. This study will discuss the effectiveness of endoscopic resection compared to esophagectomy in treating T1b esophageal adenocarcinoma.”

Researchers identified patients with T1b esophageal adenocarcinoma treated with endoscopic resection or esophagectomy between 2000 and 2016 (n = 603) in the Surveillance, Epidemiology, and End Results database. They used Kaplan-Meier estimations and Cox proportional hazard models to assess survival outcomes.

In their patient cohort, researchers found that most tumors were moderately differentiated (45%), followed by poorly differentiated (33%), then well differentiated (10.4%) and undifferentiated (1%). Most occurred in the distal third of the esophagus (83.4%), followed by the mid-esophagus (8.6%) and proximal esophagus (1.8%).

In the patient cohort, 84 patients underwent endoscopic resection (13.9%), and 367 underwent esophagectomy (60.9%).

Among patients who underwent endoscopic resection, 1-year survival was 91%, 3-year survival was 78% and 5-year survival was 74%. In patients who underwent esophagectomy, the survival rates were 91%, 85% and 73%, respectively.

In a subgroup analysis, researchers found no significant difference in mortality between the two treatments among patients with lymph node metastasis.

Lymph node metastasis was associated with 2-times higher mortality (HR = 2.16; 95% CI, 1.25-23.742), whereas surgical intervention was associated with a nonsignificant reduction in mortality (HR = 0.78; 95% CI, 0.414-1.48).

Ramai said their findings show that endoscopic resection and esophagectomy have comparable outcomes.

“Despite these findings, endoscopy remains poorly underutilized,” he said. “We propose that endoscopic resection be considered a primary therapy for treating patients with T1b esophageal adenocarcinoma.”