A matched cohort comparison of endoscopic resection, chemoradiation and esophagectomy in the treatment of early-stage esophageal squamous cell carcinoma

Am J Surg. 2023 Mar;225(3):508-513. doi: 10.1016/j.amjsurg.2022.11.040. Epub 2022 Dec 2.

Abstract

Background: The efficacy of endoscopic resection in early-stage esophageal squamous cell carcinoma has not been defined.

Methods: We queried the National Cancer Database to identify patients presenting with cT1N0M0 esophageal squamous cell cancer between 2004 and 2017. Transitive match methods were used to 1:1:1 propensity match patients undergoing endoscopic resection to patients undergoing esophagectomy and those undergoing definitive chemoradiotherapy. Kaplan Meier method was used to compare 5-year overall survival profiles for matched cohorts.

Results: 301 patients (19%) underwent endoscopic resection; 497 (32%) esophagectomy; 767 (49%) chemoradiation. On comparison of matched cohorts, patients undergoing chemoradiation demonstrated lower rates of survival than those undergoing esophagectomy (32% vs. 59%, p < 0.0001) while those undergoing endoscopic resection demonstrated rates comparable to patients undergoing esophagectomy (53% vs. 59%, p = 0.77).

Conclusions: For cT1N0M0 esophageal squamous cell cancer, endoscopic resection is associated with rates of survival similar to those following esophagectomy and better than those following definitive chemoradiation.

Keywords: Early; Endoscopic resection; Esophagectomy; Squamous cell.

MeSH terms

  • Chemoradiotherapy / methods
  • Esophageal Neoplasms*
  • Esophageal Squamous Cell Carcinoma* / surgery
  • Esophagectomy / methods
  • Humans
  • Neoplasm Staging
  • Retrospective Studies
  • Treatment Outcome