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Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer.

Publication ,  Journal Article
Merkow, RP; Bilimoria, KY; Keswani, RN; Chung, J; Sherman, KL; Knab, LM; Posner, MC; Bentrem, DJ
Published in: J Natl Cancer Inst
July 2014

BACKGROUND: Endoscopic resection is increasingly used to treat localized, early-stage esophageal cancer. We sought to assess its adoption, characterize the risks of nodal metastases, and define differences in procedural mortality and 5-year survival between endoscopic and surgical resection in the United States. METHODS: From the National Cancer Data Base, patients with T1a and T1b lesions were identified. Treatment patterns were characterized, and hierarchical regression methods were used to define predictors and evaluate outcomes. All statistical tests were two-sided. RESULTS: Five thousand three hundred ninety patients were identified and underwent endoscopic (26.5%) or surgical resection (73.5%). Endoscopic resection increased from 19.0% to 53.0% for T1a lesions (P < .001) and from 6.6% to 20.9% for T1b cancers (P < .001). The strongest predictors of endoscopic resection were depth of invasion (T1a vs T1b: odds ratio [OR] = 4.45; 95% confidence interval [CI] = 3.76 to 5.27) and patient age of 75 years or older (vs age less than 55 years: OR = 4.86; 95% CI = 3.60 to 6.57). Among patients undergoing surgery, lymph node metastasis was 5.0% for T1a and 16.6% for T1b lesions. Predictors of nodal metastases included tumor size greater than 2 cm (vs. <2 cm) and intermediate-/high-grade lesions (vs low grade). For example, 0.5% of patients with low-grade T1a lesions less than 2 cm had lymph node involvement. The risk of 30-day mortality was less after endoscopic resection (hazard ratio [HR] = 0.33; 95% CI = 0.19 to 0.58) but greater for conditional 5-year survival (HR = 1.63; 95% CI = 1.07 to 2.47). CONCLUSIONS: Endoscopic resection has become the most common treatment of T1a esophageal cancer and has increased for T1b cancers. It remains important to balance the risk of nodal metastases and procedural risk when counseling patients regarding their treatment options.

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Published In

J Natl Cancer Inst

DOI

EISSN

1460-2105

Publication Date

July 2014

Volume

106

Issue

7

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Registries
  • Predictive Value of Tests
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Merkow, R. P., Bilimoria, K. Y., Keswani, R. N., Chung, J., Sherman, K. L., Knab, L. M., … Bentrem, D. J. (2014). Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer. J Natl Cancer Inst, 106(7). https://doi.org/10.1093/jnci/dju133
Merkow, Ryan P., Karl Y. Bilimoria, Rajesh N. Keswani, Jeanette Chung, Karen L. Sherman, Lawrence M. Knab, Mitchell C. Posner, and David J. Bentrem. “Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer.J Natl Cancer Inst 106, no. 7 (July 2014). https://doi.org/10.1093/jnci/dju133.
Merkow RP, Bilimoria KY, Keswani RN, Chung J, Sherman KL, Knab LM, et al. Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer. J Natl Cancer Inst. 2014 Jul;106(7).
Merkow, Ryan P., et al. “Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer.J Natl Cancer Inst, vol. 106, no. 7, July 2014. Pubmed, doi:10.1093/jnci/dju133.
Merkow RP, Bilimoria KY, Keswani RN, Chung J, Sherman KL, Knab LM, Posner MC, Bentrem DJ. Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer. J Natl Cancer Inst. 2014 Jul;106(7).
Journal cover image

Published In

J Natl Cancer Inst

DOI

EISSN

1460-2105

Publication Date

July 2014

Volume

106

Issue

7

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Registries
  • Predictive Value of Tests
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged