Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Postbus 1350, 5602, ZA, Eindhoven, The Netherlands.
GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
Surg Endosc. 2023 Jun;37(6):4535-4544. doi: 10.1007/s00464-023-09914-x. Epub 2023 Feb 27.
Endoscopic resection for early oesophageal cancer was introduced around 2000 in the Netherlands. The scientific question was how the treatment and survival of early oesophageal and gastro-oesophageal junction cancer has changed over time in the Netherlands.
Data were obtained from the nationwide population-based Netherlands Cancer Registry. All patients diagnosed with clinical in situ or T1 oesophageal or GOJ cancer without lymph node or distance metastasis during the study period (2000-2014) were extracted. Primary outcome parameters were the trends in treatment modalities over time and relative survival of each treatment regime.
A total of 1020 patients were diagnosed with a clinical in situ or T1 oesophageal or gastro-oesophageal junction cancer without lymph node or distance metastasis. The proportion of patients who received endoscopic treatment increased from 2.5% in 2000 to 58.1% in 2014. During the same period the proportion of patients who received surgery decreased from 57.5 to 23.1%. Five-year relative survival of all patients was 69%. Five-year relative survival after endoscopic therapy was 83% and after surgery 80%. Relative excess risk analyses showed no significant difference in survival between patients in the endoscopic therapy group and patients in the surgery group after adjustment for age, sex, clinical TNM classification, morphology and tumour location (RER 1.15; CI 0.76-1.75; p 0.76).
Our results demonstrate an increase in endoscopic treatment and a decrease of surgical treatment for in situ and T1 oesophageal/GOJ cancer between 2000-2014 in the Netherlands. The relative 5-year survival after endoscopic treatment is high (83%) and comparable with surgery (80%).
内镜下切除术治疗早期食管癌于 2000 年在荷兰问世。本研究旨在探讨荷兰在过去的时间里，早期食管癌和食管胃交界部癌的治疗方式和生存情况发生了哪些变化。
本研究的数据来自全国性基于人群的荷兰癌症登记处。所有在研究期间（2000-2014 年）被诊断为临床原位或 T1 期食管或胃食管交界处癌症且无淋巴结或远处转移的患者均被纳入本研究。主要的研究终点参数为治疗方式随时间的变化趋势和每种治疗方案的相对生存率。
共纳入 1020 例临床原位或 T1 期食管或胃食管交界处癌症且无淋巴结或远处转移的患者。接受内镜治疗的患者比例从 2000 年的 2.5%增加到 2014 年的 58.1%。同期，接受手术治疗的患者比例从 57.5%下降至 23.1%。所有患者的 5 年相对生存率为 69%。内镜治疗患者的 5 年相对生存率为 83%，手术治疗患者的 5 年相对生存率为 80%。相对超额风险分析显示，在调整年龄、性别、临床 TNM 分期、形态和肿瘤位置后，内镜治疗组和手术组的患者之间的生存差异无统计学意义（RER 1.15；CI 0.76-1.75；p 0.76）。
本研究结果表明，2000-2014 年期间，荷兰接受内镜治疗的原位和 T1 期食管/胃食管交界处癌症患者比例增加，而接受手术治疗的患者比例下降。内镜治疗后的 5 年相对生存率较高（83%），与手术治疗（80%）相当。
