Survival of patients with superficial esophageal adenocarcinoma after endoscopic treatment vs surgery

Clin Gastroenterol Hepatol. 2013 Nov;11(11):1424-1429.e2; quiz e81. doi: 10.1016/j.cgh.2013.05.025. Epub 2013 Jun 2.


Background & aims: Endoscopic therapy can improve long-term outcomes of patients with superficial esophageal adenocarcinoma (EAC), producing fewer complications than esophagectomy. However, there have been few population-based studies to compare long-term outcomes of patients who received these treatments. We used a large national cancer database to evaluate the outcomes of patients with superficial EAC who underwent endoscopic therapy or surgery.

Methods: We used the Surveillance Epidemiology and End Results database to identify 1618 patients with Tis or T1 N0M0 EAC from 1998-2009. Patients were grouped on the basis of whether they received endoscopic therapy (n = 306) or surgery (n = 1312). Multivariate logistic regression was performed to identify factors associated with endoscopic therapy. We collected survival data through the end of 2009; overall survival and esophageal cancer-specific survival were compared after controlling for relevant covariates.

Results: The use of endoscopic therapy increased progressively from 3% in 1998 to 29% in 2009. Factors associated with use of endoscopic therapy included age older than 65 years, diagnosis in 2006-2009 vs 1998-2001, and the absence of submucosal invasion. Overall survival after 5 years was higher in the surgery group than in the endoscopic therapy group (70% vs 58%, respectively). After adjusting for patient and tumor factors, patients treated by endoscopy had similar overall survival times (hazard ratio, 1.21; 95% confidence interval, 0.92-1.58) and esophageal cancer-specific survival times (hazard ratio, 0.74; 95% confidence interval, 0.49-1.11).

Conclusion: In a population-based analysis, the use of endoscopic therapy for superficial EAC tended to increase from 1998-2009. Long-term survival of patients with EAC did not appear to differ between those who received endoscopic therapy and those treated with surgery.

Keywords: CI; Database Analysis; EAC; ET; Endoscopic Therapy; Esophageal Cancer; HGD; HR; OR; RFA; Retrospective Study; SEER; Surveillance Epidemiology and End Results; confidence interval; endoscopic therapy; esophageal adenocarcinoma; hazard ratio; high-grade dysplasia; odds ratio; radiofrequency ablation.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenocarcinoma / mortality*
  • Adenocarcinoma / surgery*
  • Adult
  • Aged
  • Aged, 80 and over
  • Endoscopy / methods*
  • Esophageal Neoplasms / mortality*
  • Esophageal Neoplasms / surgery*
  • Esophagectomy / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Survival Analysis
  • Treatment Outcome