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Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer.
J Natl Cancer Inst. 2014 Jul; 106(7)JNCI

Abstract

BACKGROUND

Endoscopic resection is increasingly used to treat localized, early-stage esophageal cancer. We sought to assess its adoption, characterize the risks of nodal metastases, and define differences in procedural mortality and 5-year survival between endoscopic and surgical resection in the United States.

METHODS

From the National Cancer Data Base, patients with T1a and T1b lesions were identified. Treatment patterns were characterized, and hierarchical regression methods were used to define predictors and evaluate outcomes. All statistical tests were two-sided.

RESULTS

Five thousand three hundred ninety patients were identified and underwent endoscopic (26.5%) or surgical resection (73.5%). Endoscopic resection increased from 19.0% to 53.0% for T1a lesions (P < .001) and from 6.6% to 20.9% for T1b cancers (P < .001). The strongest predictors of endoscopic resection were depth of invasion (T1a vs T1b: odds ratio [OR] = 4.45; 95% confidence interval [CI] = 3.76 to 5.27) and patient age of 75 years or older (vs age less than 55 years: OR = 4.86; 95% CI = 3.60 to 6.57). Among patients undergoing surgery, lymph node metastasis was 5.0% for T1a and 16.6% for T1b lesions. Predictors of nodal metastases included tumor size greater than 2 cm (vs. <2 cm) and intermediate-/high-grade lesions (vs low grade). For example, 0.5% of patients with low-grade T1a lesions less than 2 cm had lymph node involvement. The risk of 30-day mortality was less after endoscopic resection (hazard ratio [HR] = 0.33; 95% CI = 0.19 to 0.58) but greater for conditional 5-year survival (HR = 1.63; 95% CI = 1.07 to 2.47).

CONCLUSIONS

Endoscopic resection has become the most common treatment of T1a esophageal cancer and has increased for T1b cancers. It remains important to balance the risk of nodal metastases and procedural risk when counseling patients regarding their treatment options.

Authors+Show Affiliations

Affiliations of authors: Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center (RPM, KYB, JC, KLS, MK, DJB), Surgical Outcomes and Quality Improvement Center, Department of Surgery (RPM, KYB, JC, KLS, MK, DJB), and Department of Medicine, Division of Gastroenterology and Hepatology (RNK), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL (RPM, MCP); Department of Surgery, Jesse Brown VA Medical Center, Chicago, IL (DJB). rmerkow@facs.org.Affiliations of authors: Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center (RPM, KYB, JC, KLS, MK, DJB), Surgical Outcomes and Quality Improvement Center, Department of Surgery (RPM, KYB, JC, KLS, MK, DJB), and Department of Medicine, Division of Gastroenterology and Hepatology (RNK), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL (RPM, MCP); Department of Surgery, Jesse Brown VA Medical Center, Chicago, IL (DJB).Affiliations of authors: Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center (RPM, KYB, JC, KLS, MK, DJB), Surgical Outcomes and Quality Improvement Center, Department of Surgery (RPM, KYB, JC, KLS, MK, DJB), and Department of Medicine, Division of Gastroenterology and Hepatology (RNK), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL (RPM, MCP); Department of Surgery, Jesse Brown VA Medical Center, Chicago, IL (DJB).Affiliations of authors: Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center (RPM, KYB, JC, KLS, MK, DJB), Surgical Outcomes and Quality Improvement Center, Department of Surgery (RPM, KYB, JC, KLS, MK, DJB), and Department of Medicine, Division of Gastroenterology and Hepatology (RNK), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL (RPM, MCP); Department of Surgery, Jesse Brown VA Medical Center, Chicago, IL (DJB).Affiliations of authors: Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center (RPM, KYB, JC, KLS, MK, DJB), Surgical Outcomes and Quality Improvement Center, Department of Surgery (RPM, KYB, JC, KLS, MK, DJB), and Department of Medicine, Division of Gastroenterology and Hepatology (RNK), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL (RPM, MCP); Department of Surgery, Jesse Brown VA Medical Center, Chicago, IL (DJB).Affiliations of authors: Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center (RPM, KYB, JC, KLS, MK, DJB), Surgical Outcomes and Quality Improvement Center, Department of Surgery (RPM, KYB, JC, KLS, MK, DJB), and Department of Medicine, Division of Gastroenterology and Hepatology (RNK), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL (RPM, MCP); Department of Surgery, Jesse Brown VA Medical Center, Chicago, IL (DJB).Affiliations of authors: Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center (RPM, KYB, JC, KLS, MK, DJB), Surgical Outcomes and Quality Improvement Center, Department of Surgery (RPM, KYB, JC, KLS, MK, DJB), and Department of Medicine, Division of Gastroenterology and Hepatology (RNK), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL (RPM, MCP); Department of Surgery, Jesse Brown VA Medical Center, Chicago, IL (DJB).Affiliations of authors: Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center (RPM, KYB, JC, KLS, MK, DJB), Surgical Outcomes and Quality Improvement Center, Department of Surgery (RPM, KYB, JC, KLS, MK, DJB), and Department of Medicine, Division of Gastroenterology and Hepatology (RNK), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL (RPM, MCP); Department of Surgery, Jesse Brown VA Medical Center, Chicago, IL (DJB).

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25031273

Citation

Merkow, Ryan P., et al. "Treatment Trends, Risk of Lymph Node Metastasis, and Outcomes for Localized Esophageal Cancer." Journal of the National Cancer Institute, vol. 106, no. 7, 2014.
Merkow RP, Bilimoria KY, Keswani RN, et al. Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer. J Natl Cancer Inst. 2014;106(7).
Merkow, R. P., Bilimoria, K. Y., Keswani, R. N., Chung, J., Sherman, K. L., Knab, L. M., Posner, M. C., & Bentrem, D. J. (2014). Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer. Journal of the National Cancer Institute, 106(7). https://doi.org/10.1093/jnci/dju133
Merkow RP, et al. Treatment Trends, Risk of Lymph Node Metastasis, and Outcomes for Localized Esophageal Cancer. J Natl Cancer Inst. 2014;106(7) PubMed PMID: 25031273.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer. AU - Merkow,Ryan P, AU - Bilimoria,Karl Y, AU - Keswani,Rajesh N, AU - Chung,Jeanette, AU - Sherman,Karen L, AU - Knab,Lawrence M, AU - Posner,Mitchell C, AU - Bentrem,David J, Y1 - 2014/07/16/ PY - 2014/7/18/entrez PY - 2014/7/18/pubmed PY - 2014/9/10/medline JF - Journal of the National Cancer Institute JO - J. Natl. Cancer Inst. VL - 106 IS - 7 N2 - BACKGROUND: Endoscopic resection is increasingly used to treat localized, early-stage esophageal cancer. We sought to assess its adoption, characterize the risks of nodal metastases, and define differences in procedural mortality and 5-year survival between endoscopic and surgical resection in the United States. METHODS: From the National Cancer Data Base, patients with T1a and T1b lesions were identified. Treatment patterns were characterized, and hierarchical regression methods were used to define predictors and evaluate outcomes. All statistical tests were two-sided. RESULTS: Five thousand three hundred ninety patients were identified and underwent endoscopic (26.5%) or surgical resection (73.5%). Endoscopic resection increased from 19.0% to 53.0% for T1a lesions (P < .001) and from 6.6% to 20.9% for T1b cancers (P < .001). The strongest predictors of endoscopic resection were depth of invasion (T1a vs T1b: odds ratio [OR] = 4.45; 95% confidence interval [CI] = 3.76 to 5.27) and patient age of 75 years or older (vs age less than 55 years: OR = 4.86; 95% CI = 3.60 to 6.57). Among patients undergoing surgery, lymph node metastasis was 5.0% for T1a and 16.6% for T1b lesions. Predictors of nodal metastases included tumor size greater than 2 cm (vs. <2 cm) and intermediate-/high-grade lesions (vs low grade). For example, 0.5% of patients with low-grade T1a lesions less than 2 cm had lymph node involvement. The risk of 30-day mortality was less after endoscopic resection (hazard ratio [HR] = 0.33; 95% CI = 0.19 to 0.58) but greater for conditional 5-year survival (HR = 1.63; 95% CI = 1.07 to 2.47). CONCLUSIONS: Endoscopic resection has become the most common treatment of T1a esophageal cancer and has increased for T1b cancers. It remains important to balance the risk of nodal metastases and procedural risk when counseling patients regarding their treatment options. SN - 1460-2105 UR - https://www.unboundmedicine.com/medline/citation/25031273/Treatment_trends_risk_of_lymph_node_metastasis_and_outcomes_for_localized_esophageal_cancer_ L2 - https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/dju133 DB - PRIME DP - Unbound Medicine ER -