Division of Thoracic Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tenn.
Division of Thoracic Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tenn.
J Thorac Cardiovasc Surg. 2018 May;155(5):2211-2218.e1. doi: 10.1016/j.jtcvs.2017.11.111. Epub 2018 Jan 31.
Endoscopic resection has been rapidly adopted in the treatment of early-stage esophageal tumors. We compared the outcomes after esophagectomy or endoscopic resection for stage T1a adenocarcinoma.
We queried the National Cancer Database for patients with T1a esophageal adenocarcinoma who underwent esophagectomy or endoscopic resection and generated a balanced cohort with 735 matched pairs using propensity-score matching. We then performed a multivariable Cox regression analysis on the matched and unmatched cohorts.
We identified 2173 patients; 1317 (60.6%) underwent esophagectomy, and 856 (39.4%) underwent endoscopic resection. In the unmatched cohort, patients who underwent esophagectomy were younger, more often not treated in academic settings, and more likely to have comorbidities (30.4% vs 22.5%, P = .002). They had longer hospital stays and more readmissions than patients who underwent endoscopic resection. Factors positively affecting overall survival were younger age, resection at an academic medical center, and lower Charlson-Deyo comorbidity score. In the matched cohort, patients who underwent esophagectomy had longer hospital stays and were more likely to be readmitted within 30 days (7.0% vs 0.6%, P < .001). When a time period-specific partition was applied, endoscopic resection had a lower death hazard 0 to 90 days after resection (hazard ratio, 0.15; P = .003), but this was reversed for survival greater than 90 days (hazard ratio, 1.34; P = .02).
In patients with early-stage esophageal adenocarcinoma, survival appears equivalent after endoscopic resection or esophagectomy, but endoscopic resection is associated with shorter hospital stays, fewer readmissions, and less 90-day mortality. In patients surviving more than 90 days, esophagectomy may provide better overall survival.
内镜下切除已迅速应用于早期食管肿瘤的治疗。我们比较了 T1a 期腺癌患者行食管切除术或内镜下切除的治疗结局。
我们通过国家癌症数据库检索了接受食管切除术或内镜下切除的 T1a 期食管腺癌患者，并通过倾向评分匹配生成了 735 对匹配队列。然后，我们对匹配和未匹配队列进行了多变量 Cox 回归分析。
我们共纳入 2173 例患者，其中 1317 例（60.6%）行食管切除术，856 例（39.4%）行内镜下切除术。在未匹配队列中，行食管切除术的患者更年轻，更常不在学术机构接受治疗，且合并症更多（30.4%比 22.5%，P=0.002）。他们的住院时间更长，再入院率也高于行内镜下切除术的患者。影响总生存率的因素为年龄较小、在学术医疗中心行切除术和较低的 Charlson-Deyo 合并症评分。在匹配队列中，行食管切除术的患者住院时间更长，30 天内再入院的可能性更高（7.0%比 0.6%，P<0.001）。当应用时间特定分区时，内镜下切除术后 0 至 90 天的死亡率较低（危险比，0.15；P=0.003），但 90 天后的生存率则相反（危险比，1.34；P=0.02）。
在早期食管腺癌患者中，内镜下切除和食管切除术的生存结局相当，但内镜下切除与较短的住院时间、较低的再入院率和较低的 90 天死亡率相关。在生存时间超过 90 天的患者中，食管切除术可能提供更好的总生存率。
