Does surgery improve outcomes for esophageal squamous cell carcinoma? An analysis using the surveillance epidemiology and end results registry from 1998 to 2008.
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BACKGROUND: We examined survival associated with locally advanced esophageal squamous cell cancer (SCC) to evaluate if treatment without surgery could be considered adequate. STUDY DESIGN: Patients in the Surveillance, Epidemiology and End Results Registry (SEER) registry with stage II-III SCC of the mid or distal esophagus from 1998-2008 were grouped by treatment with definitive radiation versus esophagectomy with or without radiation. Information on chemotherapy is not recorded in SEER. Tumor stage was defined as first clinical tumor stage in case of neo-adjuvant therapy and pathological report if no neo-adjuvant therapy was performed. Cancer-specific (CSS) and overall survival (OS) were analyzed using the Kaplan-Meier approach and propensity-score adjusted Cox proportional hazard models. RESULTS: Of the 2,431 patients analyzed, there were 844 stage IIA (34.7%), 428 stage IIB (17.6%), 1,159 stage III (47.7%) patients. Most were treated with definitive radiation (n = 1,426, 58.7%). Of the 1,005 (41.3%) patients who underwent surgery, 369 (36.7%) had preoperative radiation, 160 (15.9%) had postoperative radiation, and 476 (47.4%) had no radiation. Five-year survival was 17.9% for all patients, and 22.1%, 18.5%, and 14.5% for stages IIA, IIB, and stage III, respectively. Compared to treatment that included surgery, definitive radiation alone predicted worse propensity-score adjusted survival for all patients (CSS Hazard Ratio [HR] 1.48, p < 0.001; OS HR 1.46, p < 0.001) and for stage IIA, IIB, and III patients individually (all p values ≤ 0.01). Compared to surgery alone, surgery with radiation predicted improved survival for stage III patients (CSS HR 0.62, p = 0.001, OS HR 0.62, p < 0.001) but not stage IIA or IIB (all p values > 0.18). CONCLUSIONS: Esophagectomy is associated with improved survival for patients with locally advanced SCC and should be considered as an integral component of the treatment algorithm if feasible.
Carcinoma, Squamous Cell
Published Version (Please cite this version)10.1016/j.jamcollsurg.2012.07.006
Publication InfoWorni, Mathias; Martin, J; Gloor, B; Pietrobon, Ricardo Santos; D'Amico, Thomas Anthony; Akushevich, Igor; & Berry, Mark Francis (2012). Does surgery improve outcomes for esophageal squamous cell carcinoma? An analysis using the surveillance epidemiology and end results registry from 1998 to 2008. J Am Coll Surg, 215(5). pp. 643-651. 10.1016/j.jamcollsurg.2012.07.006. Retrieved from http://hdl.handle.net/10161/14886.
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Associate Research Professor in the Social Science Research Institute
Gary Hock Professor of Surgery
Lung Cancer 1.Role of molecular markers in the prognosis and therapy of lung cancer 2.Genomic analysis lung cancer mutations Esophageal Cancer 1.Role of molecular markers in the prognosis and therapy of esophageal cancer 2.Genomic analysis esophageal cancer mutations
Medical Instructor in the Department of Surgery
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