Trends in Treatment of T1N0 Esophageal Cancer. Issue 3 (September 2019)

• Record Type: Journal Article
• Authors: Semenkovich, Tara R.; Hudson, Jessica L.; Subramanian, Melanie; Mullady, Daniel K.; Meyers, Bryan F.; Puri, Varun; Kozower, Benjamin D.
• Is Part Of: Annals of surgery. Volume 270:Issue 3(2019)
• Publication Date: 2019-09
• Subjects: endoscopic mucosal resection -- esophageal cancer -- esophagectomy; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000003466
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: The purpose of this study was to explore nationwide trends in treatment and outcomes of T1N0 esophageal cancer. Background: Endoscopic treatment has become an accepted option for early-stage esophageal cancer, but nationwide utilization rates and outcomes are unknown. Methods: T1N0 esophageal cancers were identified in the National Cancer Database from 2004 to 2014. We assessed trends in treatment; compared endoscopic therapy, esophagectomy, chemoradiation, and no treatment; and performed a subgroup analysis of T1a and T1b patients from 2010 to 2014 (AJCC 7). Results: A total of 12, 383 patients with clinical T1N0 esophageal cancer were analyzed. Over a decade, use of endoscopic therapy increased from 12.7% to 33.6%, whereas chemoradiation and esophagectomy decreased, P < 0.01. The rise in endoscopic treatment of T1a disease from 42.7% to 50.6% was accompanied by a decrease in esophagectomies from 21.7% to 12.8% ( P < 0.01). For T1b disease, the rise in endoscopic treatment from 16.9% to 25.1% ( P = 0.03) was accompanied by decreases in no treatment and chemoradiation, whereas the rate of esophagectomies remained approximately 50%. Unadjusted median survival was longer for patients undergoing resection: esophagectomy, 98.6 months; endoscopic therapy, 77.7 months; chemoradiation, 17.3 months; no treatment, 8.2 months; P < 0.01. Risk-adjusted Cox modeling showed esophagectomy was associated with improved survival [hazard ratio (HR): 0.85], and chemoradiation (HR: 1.79) and no treatment (HR: 3.57) with decreased survival, compared to endoscopic therapy ( P < 0.01). Conclusions: Use of endoscopic therapy for T1 esophageal cancer has increased significantly: for T1a, as an alternative to esophagectomy; and for T1b, as an alternative to no treatment or chemoradiation. Despite upfront risks, long-term survival is highest for patients who can undergo esophagectomy. Abstract : Supplemental Digital Content is available in the text