Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis.
Ann Surg. 2019 Sep;270(3):434-443. doi: 10.1097/SLA.0000000000003466.
The purpose of this study was to explore nationwide trends in treatment and outcomes of T1N0 esophageal cancer.
Endoscopic treatment has become an accepted option for early-stage esophageal cancer, but nationwide utilization rates and outcomes are unknown.
T1N0 esophageal cancers were identified in the National Cancer Database from 2004 to 2014. We assessed trends in treatment; compared endoscopic therapy, esophagectomy, chemoradiation, and no treatment; and performed a subgroup analysis of T1a and T1b patients from 2010 to 2014 (AJCC 7).
A total of 12,383 patients with clinical T1N0 esophageal cancer were analyzed. Over a decade, use of endoscopic therapy increased from 12.7% to 33.6%, whereas chemoradiation and esophagectomy decreased, P < 0.01. The rise in endoscopic treatment of T1a disease from 42.7% to 50.6% was accompanied by a decrease in esophagectomies from 21.7% to 12.8% (P < 0.01). For T1b disease, the rise in endoscopic treatment from 16.9% to 25.1% (P = 0.03) was accompanied by decreases in no treatment and chemoradiation, whereas the rate of esophagectomies remained approximately 50%. Unadjusted median survival was longer for patients undergoing resection: esophagectomy, 98.6 months; endoscopic therapy, 77.7 months; chemoradiation, 17.3 months; no treatment, 8.2 months; P < 0.01. Risk-adjusted Cox modeling showed esophagectomy was associated with improved survival [hazard ratio (HR): 0.85], and chemoradiation (HR: 1.79) and no treatment (HR: 3.57) with decreased survival, compared to endoscopic therapy (P < 0.01).
Use of endoscopic therapy for T1 esophageal cancer has increased significantly: for T1a, as an alternative to esophagectomy; and for T1b, as an alternative to no treatment or chemoradiation. Despite upfront risks, long-term survival is highest for patients who can undergo esophagectomy.
本研究旨在探讨 T1N0 食管癌的全国治疗趋势和结局。
内镜治疗已成为早期食管癌的一种公认选择，但全国的使用率和结局尚不清楚。
2004 年至 2014 年，国家癌症数据库中确定了 T1N0 食管癌病例。我们评估了治疗趋势；比较了内镜治疗、食管切除术、放化疗和未治疗；并对 2010 年至 2014 年的 T1a 和 T1b 患者进行了亚组分析（第 7 版 AJCC）。
共分析了 12383 例临床 T1N0 食管癌患者。十多年来，内镜治疗的使用率从 12.7%上升到 33.6%，而放化疗和食管切除术的使用率则下降，P<0.01。T1a 疾病内镜治疗的上升（从 42.7%到 50.6%）伴随着食管切除术的下降（从 21.7%到 12.8%）（P<0.01）。对于 T1b 疾病，内镜治疗的上升（从 16.9%到 25.1%）（P=0.03）伴随着未治疗和放化疗的减少，而食管切除术的比例保持在 50%左右。未调整的中位生存期对于接受切除术的患者更长：食管切除术为 98.6 个月；内镜治疗为 77.7 个月；放化疗为 17.3 个月；未治疗为 8.2 个月；P<0.01。风险调整后的 Cox 模型显示，与内镜治疗相比，食管切除术与生存改善相关[风险比（HR）：0.85]，放化疗（HR：1.79）和未治疗（HR：3.57）与生存下降相关（P<0.01）。
T1 食管癌内镜治疗的使用率显著增加：对于 T1a，内镜治疗作为食管切除术的替代方案；对于 T1b，内镜治疗作为未治疗或放化疗的替代方案。尽管存在前期风险，但能接受食管切除术的患者的长期生存率最高。
