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Endoscopic Treatment Versus Esophagectomy for Early-Stage Esophageal Cancer: a Population-Based Study Using Propensity Score Matching

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Endoscopic treatment (ET) is an alternative for selected patients with early-stage esophageal cancer. The primary aim of this study was to compare overall survival (OS) and esophageal cancer-specific survival (ECSS) of such patients after ET or esophagectomy.

Methods

Propensity score matching (PSM) and Cox regression analysis were used to compare OS and ECSS of 2661 patients with ET or esophagectomy for early-stage (Tis–T1N0M0) disease. Patient information was retrieved from the Surveillance, Epidemiology, and End Results database. Subgroup analyses by T stage and tumor histology were also performed.

Results

There were significant differences in age, sex ratio, year of diagnosis, cancer site, cancer stage, differentiation grade, tumor histology, tumor size, lymph nodes examined, and receipt of radiation therapy in the two treatment groups. PSM created 621 patient pairs. Multivariate analysis found no significant differences in OS (HR = 1.216, P = 0.279) or ECSS (HR = 0.692, P = 0.179) in the esophagectomy and ET groups. The results were similar for subgroup analyses limited to stage Tis, T1a, and T1b patients. ET was also associated with similar OS and ECSS in esophageal adenocarcinoma and squamous cell carcinoma patients.

Conclusion

In this population-based study using PSM, patients with stage Tis and T1N0M0 esophageal cancer with ET had OS and ECSS comparable to those treated by esophagectomy after adjusting for clinical variables. The results support ET as an alternative to esophagectomy in early esophageal cancer.

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Acknowledgements

We thank “International Science Editing” for helping to edit the manuscript.

Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, People’s Republic of China

    Yuan Zeng, Wenhua Liang, Jun Liu & Jianxing He

  2. Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China

    Yuan Zeng, Wenhua Liang, Jun Liu & Jianxing He

Authors
  1. Yuan Zeng
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  2. Wenhua Liang
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  3. Jun Liu
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  4. Jianxing He
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Contributions

Study conception and design: Jianxing He and Yuan Zeng

Collection and assembly of data: Yuan Zeng, Jun Liu, and Wenhua Liang

Data analysis and interpretation: Jianxing He, Yuan Zeng, and Wenhua Liang

Manuscript preparation, revision, and final approval: All authors

Corresponding author

Correspondence to Jianxing He.

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The authors declare that they have no conflict of interest.

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Zeng, Y., Liang, W., Liu, J. et al. Endoscopic Treatment Versus Esophagectomy for Early-Stage Esophageal Cancer: a Population-Based Study Using Propensity Score Matching. J Gastrointest Surg 21, 1977–1983 (2017). https://doi.org/10.1007/s11605-017-3563-2

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  • DOI: https://doi.org/10.1007/s11605-017-3563-2

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