Trends in Treatment of T1N0 Esophageal Cancer
Trends in Treatment of T1N0 Esophageal Cancer
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DOI：
10.1097/sla.0000000000003466
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发表时间：
2019-09-01
影响因子：
9
通讯作者：
Kozower, Benjamin D.
中科院分区：
文献类型：
--
作者：
Semenkovich, Tara R.;Hudson, Jessica L.;Kozower, Benjamin D.
目的：本研究的目的是探讨全国范围内T1N0食管癌的治疗趋势和预后。背景：内镜治疗已成为早期食管癌的一种可接受的选择，但全国范围内的使用率和结果尚不清楚。方法：2004 - 2014年在国家癌症数据库中发现T1N0例食管癌。我们评估了治疗趋势；比较内镜治疗、食管切除术、放化疗和不治疗；并对2010 - 2014年T1a和T1b患者进行亚组分析（AJCC 7）。结果：共分析临床T1N0食管癌患者12383例。十年来，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下降，P < 0.01。内镜下治疗T1a疾病的比例从42.7%上升到50.6%，食管切除术的比例从21.7%下降到12.8% （P < 0.01）。对于T1b疾病，内镜治疗的比例从16.9%上升到25.1% (P = 0.03)，同时不治疗和放化疗的比例下降，而食管切除术的比例保持在50%左右。接受切除术的患者的未调整中位生存期更长：食管切除术为98.6个月；内镜治疗，77.7个月；放化疗，17.3个月；未治疗，8.2个月；P < 0.01。风险校正Cox模型显示，与内镜治疗相比，食管切除术与生存率提高相关[风险比（HR）： 0.85]，放化疗（HR: 1.79）和不治疗（HR: 3.57）与生存率降低相关（P < 0.01）。结论：内镜治疗在T1食管癌中的应用显著增加：对于T1a食管癌，作为食管切除术的替代方案；对于T1b，作为不治疗或放化疗的替代方案。尽管存在前期风险，但接受食管切除术的患者的长期生存率最高。
Objective: The purpose of this study was to explore nationwide trends in treatment and outcomes of T1N0 esophageal cancer. Background: Endoscopic treatment has become an accepted option for early-stage esophageal cancer, but nationwide utilization rates and outcomes are unknown. Methods: 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). Results: 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). Conclusions: 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.