A comparison of endoscopic treatment and surgery in early esophageal cancer: An analysis of surveillance epidemiology and end results data

OBJECTIVES: Endoscopic therapy for early esophageal cancer is gaining gradual acceptance in the United States. However, little information is available regarding long-term outcome of endoscopic therapy compared to surgical treatment of early esophageal cancer. We aimed to analyze outcomes in terms of cancer-free survival in patients with early esophageal cancer managed with either endoscopic therapy or surgical resection. METHODS: The Surveillance Epidemiology and End Results database of the National Cancer Institute was searched to identify all patients who were diagnosed with stage 0 and stage 1 nonsquamous and squamous cell-type esophageal cancer between 1998 and 2003. Data on demographic features, tumor characteristics, types of treatment received (endoscopic vs surgical resection), and esophageal cancer-specific mortality were analyzed. RESULTS: Data were available for analysis in 742 patients with early esophageal cancer. Only 99 (13.3%) of these underwent endoscopic treatment (group A). The remainder of the patients was managed by surgical resection (group B). In the Cox proportional hazards model, the relative hazard for esophageal cancer-specific mortality in group A was not different from that of group B (relative hazard [RH] 0.89, 95% confidence interval [CI] 0.51-1.56, P = 0.68). The significant predictors of survival were age at diagnosis (RH 1.06, 95% CI 1.03-1.08, P < 0.001) and absence of exposure to radiation therapy (RH 0.32, 95% CI 0.21-0.48, P < 0.001). CONCLUSIONS: Patients with early esophageal cancer managed with endoscopic therapy have equivalent long-term survival compared to those treated with surgical resection. These are the first population-based data that support the effectiveness of endoscopic therapy for managing these patients.