Survival of Patients With Superficial Esophageal Adenocarcinoma After Endoscopic Treatment vs Surgery

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.