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

Berry, Mark F.; Zeyer-Brunner, Josiane; Castleberry, Anthony W.; Martin, Jeremiah T.; Gloor, Beat; Pietrobon, Ricardo; D'Amico, Thomas A.; Worni, Mathias (2013). Treatment modalities for T1N0 esophageal cancers: a comparative analysis of local therapy versus surgical resection. Journal of thoracic oncology, 8(6), pp. 796-802. Wolters Kluwer Health/Lippincott Williams & Wilkins 10.1097/JTO.0b013e3182897bf1

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BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery
04 Faculty of Medicine > Service Sector > Institute of Legal Medicine > Forensic Medicine

UniBE Contributor:

Zeyer, Josiane; Gloor, Beat and Worni, Mathias

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1556-0864

Publisher:

Wolters Kluwer Health/Lippincott Williams & Wilkins

Language:

English

Submitter:

Lilian Karin Smith-Wirth

Date Deposited:

17 Jun 2014 10:20

Last Modified:

20 Dec 2014 05:54

Publisher DOI:

10.1097/JTO.0b013e3182897bf1

PubMed ID:

24614244

BORIS DOI:

10.7892/boris.53186

URI:

https://boris.unibe.ch/id/eprint/53186

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