A comparison of endoscopic treatment and surgery in early esophageal cancer: An analysis of surveillance epidemiology and end results data

Ananya Das, Vandana Singh, David E. Fleischer, Virender K. Sharma

Research output: Contribution to journalArticle

108 Citations (Scopus)

Abstract

OBJECTIVES: Endoscopic therapy for early esophageal cancer is gaining gradual acceptance in the United States. However, little information is available regarding long-term outcome of endoscopic therapy compared to surgical treatment of early esophageal cancer. We aimed to analyze outcomes in terms of cancer-free survival in patients with early esophageal cancer managed with either endoscopic therapy or surgical resection. METHODS: The Surveillance Epidemiology and End Results database of the National Cancer Institute was searched to identify all patients who were diagnosed with stage 0 and stage 1 nonsquamous and squamous cell-type esophageal cancer between 1998 and 2003. Data on demographic features, tumor characteristics, types of treatment received (endoscopic vs surgical resection), and esophageal cancer-specific mortality were analyzed. RESULTS: Data were available for analysis in 742 patients with early esophageal cancer. Only 99 (13.3%) of these underwent endoscopic treatment (group A). The remainder of the patients was managed by surgical resection (group B). In the Cox proportional hazards model, the relative hazard for esophageal cancer-specific mortality in group A was not different from that of group B (relative hazard [RH] 0.89, 95% confidence interval [CI] 0.51-1.56, P = 0.68). The significant predictors of survival were age at diagnosis (RH 1.06, 95% CI 1.03-1.08, P < 0.001) and absence of exposure to radiation therapy (RH 0.32, 95% CI 0.21-0.48, P < 0.001). CONCLUSIONS: Patients with early esophageal cancer managed with endoscopic therapy have equivalent long-term survival compared to those treated with surgical resection. These are the first population-based data that support the effectiveness of endoscopic therapy for managing these patients.

Original languageEnglish (US)
Pages (from-to)1340-1345
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume103
Issue number6
DOIs
StatePublished - Jun 2008

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Esophageal Neoplasms
Epidemiology
Confidence Intervals
Therapeutics
Survival
Squamous Cell Neoplasms
National Cancer Institute (U.S.)
Mortality
Proportional Hazards Models
Neoplasms
Radiotherapy
Demography
Databases
Population

ASJC Scopus subject areas

  • Gastroenterology

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A comparison of endoscopic treatment and surgery in early esophageal cancer : An analysis of surveillance epidemiology and end results data. / Das, Ananya; Singh, Vandana; Fleischer, David E.; Sharma, Virender K.

In: American Journal of Gastroenterology, Vol. 103, No. 6, 06.2008, p. 1340-1345.

Research output: Contribution to journalArticle

Das, Ananya ; Singh, Vandana ; Fleischer, David E. ; Sharma, Virender K. / A comparison of endoscopic treatment and surgery in early esophageal cancer : An analysis of surveillance epidemiology and end results data. In: American Journal of Gastroenterology. 2008 ; Vol. 103, No. 6. pp. 1340-1345.
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abstract = "OBJECTIVES: Endoscopic therapy for early esophageal cancer is gaining gradual acceptance in the United States. However, little information is available regarding long-term outcome of endoscopic therapy compared to surgical treatment of early esophageal cancer. We aimed to analyze outcomes in terms of cancer-free survival in patients with early esophageal cancer managed with either endoscopic therapy or surgical resection. METHODS: The Surveillance Epidemiology and End Results database of the National Cancer Institute was searched to identify all patients who were diagnosed with stage 0 and stage 1 nonsquamous and squamous cell-type esophageal cancer between 1998 and 2003. Data on demographic features, tumor characteristics, types of treatment received (endoscopic vs surgical resection), and esophageal cancer-specific mortality were analyzed. RESULTS: Data were available for analysis in 742 patients with early esophageal cancer. Only 99 (13.3{\%}) of these underwent endoscopic treatment (group A). The remainder of the patients was managed by surgical resection (group B). In the Cox proportional hazards model, the relative hazard for esophageal cancer-specific mortality in group A was not different from that of group B (relative hazard [RH] 0.89, 95{\%} confidence interval [CI] 0.51-1.56, P = 0.68). The significant predictors of survival were age at diagnosis (RH 1.06, 95{\%} CI 1.03-1.08, P < 0.001) and absence of exposure to radiation therapy (RH 0.32, 95{\%} CI 0.21-0.48, P < 0.001). CONCLUSIONS: Patients with early esophageal cancer managed with endoscopic therapy have equivalent long-term survival compared to those treated with surgical resection. These are the first population-based data that support the effectiveness of endoscopic therapy for managing these patients.",
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