Division of Thoracic and Foregut Surgery, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
J Am Coll Surg. 2010 Dec;211(6):754-61. doi: 10.1016/j.jamcollsurg.2010.07.029. Epub 2010 Oct 25.
Although esophagectomy provides the highest probability of cure in patients with esophageal cancer, many candidates are never referred for surgery. We hypothesized that esophagectomy for esophageal cancer is underused, and we assessed the prevalence of resection in national, state, and local cancer data registries.
Clinical stage, surgical and nonsurgical treatments, age, and race of patients with cancer of the esophagus were identified from the Surveillance, Epidemiology and End Results (SEER) registry (1988 to 2004), the Healthcare Association of NY State registry (HANYS 2007), and a single referral center (2000 to 2007). SEER identified a total of 25,306 patients with esophageal cancer (average age 65.0 years, male-to-female ratio 3:1). HANYS identified 1,012 cases of esophageal cancer (average age 67 years, M:F ratio 3:1); stage was not available from NY State registry data. A single referral center identified 385 patients (48 per year; average age 67 years, M:F 3:1). For SEER data, logistic regression was used to examine determinants of esophageal resection; variables tested included age, race, and gender.
Surgical exploration was performed in 29% of the total and only 44.2% of potentially resectable patients. Esophageal resection was performed in 44% of estimated cancer patients in NY State. By comparison, 64% of patients at a specialized referral center underwent surgical exploration, 96% of whom had resection. SEER resection rates for esophageal cancer did not change between 1988 and 2004. Males were more likely to receive operative treatment. Nonwhites were less likely to undergo surgery than whites (odds ratio 0.45, p < 0.001).
Surgical therapy for locoregional esophageal cancer is likely underused. Racial variations in esophagectomy are significant. Referral to specialized centers may result in an increase in patients considered for surgical therapy.
尽管食管癌切除术为患者提供了治愈的最高可能性，但许多患者从未被转介进行手术。我们假设食管癌切除术的应用不足，并评估了国家、州和地方癌症数据登记处的切除术患病率。
从监测、流行病学和最终结果（SEER）登记处（1988 年至 2004 年）、纽约州医疗保健协会（HANYS）登记处（2007 年）和单一转诊中心（2000 年至 2007 年）中确定了癌症患者的临床分期、手术和非手术治疗、年龄和种族。SEER 共确定了 25306 例食管癌患者（平均年龄 65.0 岁，男女比例为 3:1）。HANYS 确定了 1012 例食管癌（平均年龄 67 岁，男女比例 3:1）；纽约州登记处的数据没有提供分期信息。单一转诊中心确定了 385 例患者（每年 48 例；平均年龄 67 岁，男女比例 3:1）。对于 SEER 数据，使用逻辑回归检查了食管癌切除术的决定因素；测试的变量包括年龄、种族和性别。
总共有 29%的患者接受了手术探查，只有 44.2%的潜在可切除患者接受了手术。纽约州估计有 44%的癌症患者接受了食管切除术。相比之下，专门转诊中心的 64%的患者接受了手术探查，其中 96%的患者接受了切除术。1988 年至 2004 年间，SEER 食管癌切除术率没有变化。男性更有可能接受手术治疗。与白人相比，非白人接受手术的可能性较低（比值比 0.45，p<0.001）。
局部区域食管癌的手术治疗可能应用不足。食管癌切除术的种族差异显著。转介至专门中心可能会增加考虑手术治疗的患者数量。
