Daryl Ramai, MD1, Jameel Singh, MD2, Gandhi Lanke, MD3, Mohamed Barakat, MD4, Saurabh Chandan, MD5, Javier Escovar, MD4, Andrew Ofosu, MD4, Sahar K. Takkouche, MD6, Olivia W. Brooks, MS7, Ogenetega Madedor, MS7, Jonathan Lai, MD8, Amaninder Dhaliwal, MD5, Douglas G. Adler, MD9; 1The Brooklyn Hospital Center, Brooklyn, NY; 2Brooklyn Hospital Center, Port Jefferson, NY; 3Covenant Hospital, Lubbock, TX; 4Brooklyn Hospital Center, Brooklyn, NY; 5University of Nebraska Medical Center, Omaha, NE; 6Vanderbilt University, New York, NY; 7St. George's University School of Medicine, Brooklyn, NY; 8McGill University, Montreal, PQ, Canada; 9University of Utah School of Medicine, Salt Lake City, UT
Introduction: Current guidelines recommend consideration of endoscopic therapy when treating T1a esophageal adenocarcinoma. However, it remains unclear if endoscopy is appropriate for treating T1b lesions with and without lymph node metastasis. Our study aims to compare survival outcomes following surgical resection and endoscopy in treating T1b esophageal adenocarcinoma. Methods: We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results database from 2000 to 2016 of patients with T1b esophageal adenocarcinoma treated with endoscopic resection or esophagectomy. Kaplan Meier estimations and cox proportional hazards models were used to assess survival outcomes. Results: A total of 603 patients with T1b esophageal carcinoma were identified, of whom 87.7% were male. Median age at diagnosis was 67 ± 10.6 years. Overall, males had a higher prevalence of T1b esophageal carcinoma compared to females (87.7% vs. 12.1 per 100,000 per year). Tumors were most common among White patients (95.2%). Most tumors were moderately differentiated (45%), followed by poorly differentiated (33%), well differentiated (10.4%), and undifferentiated (1.0%). Most tumors occurred in the distal third of the esophagus (83.4%) followed by the mid esophagus (8.6%) and the proximal third (1.8%). About 84 (13.9%) underwent endoscopic resection and 367 (60.9%) underwent esophagectomy. One, 3- and 5-year survival for cancer-specific death was associated with survival rates of 91%, 78%, and 74%, respectively, for endoscopic resection. Esophagectomy was associated with 1-, 3 and 5-year survival rates of 91%, 85%, and 73%, respectively. Subgroup analysis showed that in patients with lymph node metastasis (LMN), no significant difference in mortality was observed following surgical and endoscopic resection (Log Rank test = 0.903). Adjusted hazard models indicated that LMN was associated with 2 times higher mortality [HR 2.16, 95% CI 1.250-23.742, p=0.0.006], and surgical intervention was associated with a non-significant reduction in mortality [HR 0.78, 95% CI 0.414-1.480, p=0.451]. Discussion: Endoscopic resection was associated with similar cancer-specific survival outcomes compared with esophagectomy in stage T1b esophageal adenocarcinoma, regardless of lymph node metastasis. Endoscopic removal of T1b esophageal adenocarcinoma is an effective strategy for patients including those either refusing esophagectomy or not a candidate for surgical intervention.
Survival following endoscopic resection (ER) and surgical resection (SR).
Disclosures: Daryl Ramai indicated no relevant financial relationships. Jameel Singh indicated no relevant financial relationships. Gandhi Lanke indicated no relevant financial relationships. Mohamed Barakat indicated no relevant financial relationships. Saurabh Chandan indicated no relevant financial relationships. Javier Escovar indicated no relevant financial relationships. Andrew Ofosu indicated no relevant financial relationships. Sahar Takkouche indicated no relevant financial relationships. Olivia Brooks indicated no relevant financial relationships. Ogenetega Madedor indicated no relevant financial relationships. Jonathan Lai indicated no relevant financial relationships. Amaninder Dhaliwal indicated no relevant financial relationships. Douglas Adler indicated no relevant financial relationships.