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A matched cohort comparison of endoscopic resection, chemoradiation and esophagectomy in the treatment of early-stage esophageal squamous cell carcinoma

Published:December 01, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.11.040

      Highlights

      • Endoscopic resection for cT1N0M0 squamous cell carcinoma had comparable survival rates to esophagectomy.
      • Esophagectomy and endoscopic resection had a risk-adjusted absolute survival advantage of 27% and 21% relative to CRT.
      • Endoscopic resection was associated with accelerated rates of post-operative recovery but higher rates of R1 resection.

      Abstract

      Background

      The efficacy of endoscopic resection in early-stage esophageal squamous cell carcinoma has not been defined.

      Methods

      We queried the National Cancer Database to identify patients presenting with cT1N0M0 esophageal squamous cell cancer between 2004 and 2017. Transitive match methods were used to 1:1:1 propensity match patients undergoing endoscopic resection to patients undergoing esophagectomy and those undergoing definitive chemoradiotherapy. Kaplan Meier method was used to compare 5-year overall survival profiles for matched cohorts.

      Results

      301 patients (19%) underwent endoscopic resection; 497 (32%) esophagectomy; 767 (49%) chemoradiation. On comparison of matched cohorts, patients undergoing chemoradiation demonstrated lower rates of survival than those undergoing esophagectomy (32% vs. 59%, p < 0.0001) while those undergoing endoscopic resection demonstrated rates comparable to patients undergoing esophagectomy (53% vs. 59%, p = 0.77).

      Conclusions

      For cT1N0M0 esophageal squamous cell cancer, endoscopic resection is associated with rates of survival similar to those following esophagectomy and better than those following definitive chemoradiation.

      Keywords

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      References

        • Wang C.-Y.
        • Chen B.-H.
        • Lee C.-H.
        • Le P.-H.
        • Tsou Y.-K.
        • Lin C.-H.
        cT1N0M0 esophageal squamous cell carcinoma invades the muscularis mucosa or submucosa: comparison of the results of endoscopic submucosal dissection and esophagectomy.
        Cancers. 2022; 14: 424
        • Zhang Y.
        • Ding H.
        • Chen T.
        • et al.
        Outcomes of endoscopic submucosal dissection vs esophagectomy for T1 esophageal squamous cell carcinoma in a real-world cohort.
        Clin Gastroenterol Hepatol: Offc Clinic Pract J AM Gastroenterol Assoc. 2019; 17: 73-81
        • Min Y.W.
        • Lee H.
        • Song B.G.
        • et al.
        Comparison of endoscopic submucosal dissection and surgery for superficial esophageal squamous cell carcinoma: a propensity score-matched analysis.
        Gastrointest Endosc. 2018; 88: 624-633
      1. NCCN. NCCN Clinical Practice Guidelines in Oncology: Esophageal and Esophagogastric Junction Cancers. Version 2.2022.

        • White I.R.
        • Royston P.
        • Wood A.M.
        Multiple imputation using chained equations: issues and guidance for practice.
        Stat Med. 2011; 30: 377-399https://doi.org/10.1002/sim.4067
        • Yamamoto S.
        • Ishihara R.
        • Motoori M.
        • et al.
        Comparison between definitive chemoradiotherapy and esophagectomy in patients with clinical stage I esophageal squamous cell carcinoma.
        Am J Gastroenterol. 2011; 106: 1048-1054
        • Motoori M.
        • Yano M.
        • Ishihara R.
        • et al.
        Comparison between radical esophagectomy and definitive chemoradiotherapy in patients with clinical T1bN0M0 esophageal cancer.
        Ann Surg Oncol. 2012; 19: 2135-2141
        • van Hagen P.
        • Hulshof M.C.C.M.
        • van Lanschot J.J.B.
        • et al.
        Preoperative chemoradiotherapy for esophageal or junctional cancer.
        N Engl J Med. 2012; 366: 2074-2084
        • Leers J.M.
        • DeMeester S.R.
        • Oezcelik A.
        • et al.
        The prevalence of lymph node metastases in patients with T1 esophageal adenocarcinoma a retrospective review of esophagectomy specimens.
        Ann Surg. 2011; 253: 271-278