Wani Sachin, Das Ananya, Rastogi Amit, Drahos Jennifer, Ricker Winifred, Parsons Ruth, Bansal Ajay, Yen Roy, Hosford Lindsay, Jankowski Meghan, Sharma Prateek, Cook Michael B
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado; Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Denver, Colorado.
Cancer. 2015 Jan 15;121(2):194-201. doi: 10.1002/cncr.29043. Epub 2014 Sep 18.
The advantages of endoscopic ultrasound (EUS) and computed tomography (CT)-positron emission tomography (PET) with respect to survival for esophageal cancer patients are unclear. This study aimed to assess the effects of EUS, CT-PET, and their combination on overall survival with respect to cases not receiving these procedures.
Patients who were ≥66 years old when diagnosed with esophageal cancer were identified in the Surveillance, Epidemiology, and End Results-Medicare linked database. Cases were split into 4 analytic groups: EUS only (n = 318), CT-PET only (n = 853), EUS+CT-PET (n = 189), and no EUS or CT-PET (n = 2439). Survival times were estimated with the Kaplan-Meier method and were compared with the log-rank test for each group versus the no EUS or CT-PET group. Multivariate Cox proportional hazards models were used to compare 1-, 3-, and 5-year survival rates.
Kaplan-Meier analyses showed that EUS, CT-PET, and EUS+CT-PET patients had improved survival for all stages (with the exception of stage 0 disease) in comparison with patients undergoing no EUS or CT-PET. Receipt of EUS increased the likelihood of receiving endoscopic therapies, esophagectomy, and chemoradiation. Multivariate Cox proportional hazards models showed that receipt of EUS was a significant predictor of improved 1- (hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.39-0.59; P < .0001), 3- (HR, 0.57; 95% CI, 0.48-0.66; P < .0001), and 5-year survival (HR, 0.59; 95% CI, 0.50-0.68). Similar results were noted when the results were stratified on the basis of histology and for the CT-PET and EUS+CT-PET groups.
Receipt of either EUS or CT-PET alone in esophageal cancer patients was associated with improved 1-, 3-, and 5-year survival. Future studies should identify barriers to the dissemination of these staging modalities.
关于内镜超声（EUS）和计算机断层扫描（CT）-正电子发射断层扫描（PET）对食管癌患者生存率的优势尚不清楚。本研究旨在评估EUS、CT-PET及其联合应用对未接受这些检查的患者总生存期的影响。
在监测、流行病学和最终结果-医疗保险链接数据库中识别出诊断为食管癌时年龄≥66岁的患者。病例分为4个分析组：仅接受EUS组（n = 318）、仅接受CT-PET组（n = 853）、EUS + CT-PET组（n = 189）和未接受EUS或CT-PET组（n = 2439）。采用Kaplan-Meier方法估计生存时间，并通过对数秩检验比较每组与未接受EUS或CT-PET组的生存时间。使用多变量Cox比例风险模型比较1年、3年和5年生存率。
Kaplan-Meier分析显示，与未接受EUS或CT-PET的患者相比，EUS、CT-PET和EUS + CT-PET患者在所有分期（0期疾病除外）的生存率均有所提高。接受EUS增加了接受内镜治疗、食管切除术和放化疗的可能性。多变量Cox比例风险模型显示，接受EUS是1年（风险比[HR]，0.49；95%置信区间[CI]，0.39 - 0.59；P <.0001）、3年（HR，0.57；95% CI，0.48 - 0.66；P <.0001）和5年生存率提高的显著预测因素（HR，0.59；95% CI，0.50 - 0.68）。当根据组织学进行分层以及对CT-PET和EUS + CT-PET组进行分析时，也得到了类似的结果。
食管癌患者单独接受EUS或CT-PET均与1年、3年和5年生存率的提高相关。未来的研究应确定这些分期方式推广的障碍。
