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Endoscopic resection versus esophagectomy for patients with small-sized T1N0 esophageal cancer: A propensity-matched study - 22/10/20

Doi : 10.1016/j.clinre.2020.09.004 
Wenjia Wang a, 1, Donglai Chen b, 1, Yonghua Sang a, 1, Chang Chen b, Yongsheng Zhang c, 2, Yiming Mao d, 2, Yongbing Chen a, 2,
a Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China 
b Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China 
c Department of Pathology, The Second Affiliated Hospital of Soochow University, Suzhou, China 
d Department of Thoracic Surgery, Suzhou Kowloon Hospital Shanghai Jiaotong University School of Medicine, Suzhou, China 

Corresponding author at: 1055 Sanxiang Road, Gusu District, Suzhou 215004, China.1055 Sanxiang RoadGusu DistrictSuzhou215004China
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 22 October 2020

Highlights

Endoscopic resection was similar to surgery in stage T1 (≤2 cm) esophageal cancer.
Patients treated endoscopically may dead of causes other than tumors at a higher rate.
T1b patients were dying from esophageal cancer at a higher rate than T1a patients.
The only study based on the eighth edition of TNM staging system of esophageal cancer.

Le texte complet de cet article est disponible en PDF.

Summary

Objectives

Endoscopic resection (ER) has been rapidly adopted in the treatment of early-stage esophageal cancer. We aimed to compare the outcomes of ER with esophagectomy for patients with small-sized (≤2 cm) stage T1a and T1b esophageal cancer in a population-based cohort.

Methods

We queried the Surveillance, Epidemiology, and End Results database for patients with T1N0M0 esophageal cancer who underwent ER or esophagectomy and generated a balanced cohort with 217 matched pairs using propensity score matching (PSM). Kaplan–Meier method and multivariable Cox regression analysis were employed to investigate the matched cohort. Subgroup analyses of T stage were also performed.

Results

We identified 702 patients; 309 (44.0 %) underwent ER, and 393 (56.0 %) underwent esophagectomy. In the unmatched cohort, patients who underwent ER were older, more likely to have a T1a stage, and less likely to receive lymph node sampling. In the entire matched cohort, multivariate analysis found esophagectomy were associated with better overall survival (OS) (HR: 0.62, 95 % CI: 0.40–0.96, p = 0.032) than ER, but no significant difference in esophageal cancer-specific survival (ECSS) (HR: 1.37, 95 % CI: 0.64–2.96, p = 0.420) between the two procedures. The results were similar for subgroup analyses of stage T1b patients. However, ER and esophagectomy were associated with similar OS (HR: 0.74, 95 % CI: 0.41–1.36; p = 0.334) and ECSS (HR: 3.69, 95 % CI: 0.95–14.39; p = 0.060) in patients with stage T1a disease.

Conclusions

In patients with stage T1 esophageal cancer, ER was similar to esophagectomy in terms of oncologic outcomes. More prospective studies should be implemented to determine the optimal treatment for T1b esophageal cancer patients with risk factors.

Le texte complet de cet article est disponible en PDF.

Abbreviations : ER, NCCN, SEER, OS, ECSS, PSM, LNM, HR, CI, LVI

Keywords : Esophageal cancer, Endoscopic resection, Esophagectomy, Survival, SEER program


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