Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, People's Republic of China.
Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.
J Gastrointest Surg. 2017 Dec;21(12):1977-1983. doi: 10.1007/s11605-017-3563-2. Epub 2017 Oct 13.
Endoscopic treatment (ET) is an alternative for selected patients with early-stage esophageal cancer. The primary aim of this study was to compare overall survival (OS) and esophageal cancer-specific survival (ECSS) of such patients after ET or esophagectomy.
Propensity score matching (PSM) and Cox regression analysis were used to compare OS and ECSS of 2661 patients with ET or esophagectomy for early-stage (Tis-T1N0M0) disease. Patient information was retrieved from the Surveillance, Epidemiology, and End Results database. Subgroup analyses by T stage and tumor histology were also performed.
There were significant differences in age, sex ratio, year of diagnosis, cancer site, cancer stage, differentiation grade, tumor histology, tumor size, lymph nodes examined, and receipt of radiation therapy in the two treatment groups. PSM created 621 patient pairs. Multivariate analysis found no significant differences in OS (HR = 1.216, P = 0.279) or ECSS (HR = 0.692, P = 0.179) in the esophagectomy and ET groups. The results were similar for subgroup analyses limited to stage Tis, T1a, and T1b patients. ET was also associated with similar OS and ECSS in esophageal adenocarcinoma and squamous cell carcinoma patients.
In this population-based study using PSM, patients with stage Tis and T1N0M0 esophageal cancer with ET had OS and ECSS comparable to those treated by esophagectomy after adjusting for clinical variables. The results support ET as an alternative to esophagectomy in early esophageal cancer.
内镜治疗（ET）是早期食管癌患者的一种替代治疗方法。本研究的主要目的是比较接受 ET 或食管切除术的此类患者的总生存率（OS）和食管癌特异性生存率（ECSS）。
使用倾向评分匹配（PSM）和 Cox 回归分析比较了 2661 例接受 ET 或食管切除术治疗早期（Tis-T1N0M0）疾病的患者的 OS 和 ECSS。患者信息从监测、流行病学和最终结果数据库中检索。还进行了 T 分期和肿瘤组织学的亚组分析。
两组患者在年龄、性别比例、诊断年份、癌症部位、癌症分期、分化程度、肿瘤组织学、肿瘤大小、检查的淋巴结数量以及放疗的接受情况方面存在显著差异。PSM 建立了 621 对患者。多变量分析发现，食管切除术和 ET 组在 OS（HR=1.216，P=0.279）或 ECSS（HR=0.692，P=0.179）方面无显著差异。对限于Tis、T1a 和 T1b 期患者的亚组分析的结果也相似。ET 也与食管腺癌和鳞状细胞癌患者的相似 OS 和 ECSS 相关。
在本项基于人群的 PSM 研究中，调整临床变量后，Tis 和 T1N0M0 期食管癌患者接受 ET 的 OS 和 ECSS 与接受食管切除术的患者相当。这些结果支持 ET 作为早期食管癌的替代治疗方法。
