Treatment modalities for T1N0 esophageal cancers: a comparative analysis of local therapy versus surgical resection.

Published

Journal Article

To investigate the role of nonsurgical treatment for early-stage esophageal cancer, we compared the outcomes of local therapy to esophagectomy, using a large, national database.Five-year cancer-specific and overall survival (OS) of patients, with T1N0M0 squamous cell or adenocarcinoma of the mid or distal esophagus treated with either surgery or local therapy, with ablative and/or excision techniques, in the Surveillance Epidemiology and End Results cancer registry from 1998 to 2008, were compared using the Kaplan-Meier approach, and multivariable and propensity-score adjusted Cox proportional hazard, and competing risk models.Of 1458 patients with T1N0 esophageal cancer, 1204 (83%) had surgery and 254 (17%) had local therapy only. The use of local therapy increased significantly from 8.1% in 1998 to 24.1% in 2008 (p < 0.001). The 5-year OS after local excisional therapy and surgery was not significantly different (55.5% versus 64.1% respectively, p = 0.07), and 5-year cancer-specific survival (CSS) also did not differ (81.7% versus 75.8%, p = 0.10). However, after propensity-score adjustment, CSS was better for patients who underwent local therapy compared with those who underwent surgery (hazard ratio: 0.46, 95% confidence interval: 0.27-0.77, p = 0.003), whereas OS remained similar.The use of local therapy for T1N0 esophageal cancers increased significantly from 1998 to 2008. Compared with those treated with esophagectomy, patients treated with local therapy had similar OS but improved CSS, indicating a higher chance of dying from other causes. Further studies are needed to confirm the oncologic efficacy of local therapy when used in patients whose lifespans are not limited by conditions other than esophageal cancer.

Full Text

Duke Authors

Cited Authors

  • Berry, MF; Zeyer-Brunner, J; Castleberry, AW; Martin, JT; Gloor, B; Pietrobon, R; D'Amico, TA; Worni, M

Published Date

  • June 2013

Published In

Volume / Issue

  • 8 / 6

Start / End Page

  • 796 - 802

PubMed ID

  • 24614244

Pubmed Central ID

  • 24614244

Electronic International Standard Serial Number (EISSN)

  • 1556-1380

International Standard Serial Number (ISSN)

  • 1556-0864

Digital Object Identifier (DOI)

  • 10.1097/JTO.0b013e3182897bf1

Language

  • eng