Introduction Currently only 1 in 20 oesophageal adenocarcinomas are diagnosed at early stage.1 Where patients are diagnosed at an early stage, studies have suggested that up to 90% of patients managed with curative surgical intent survive 5 years.2
In this study we investigated the changing patterns of management for oesophageal adenocarcinomas in England and Wales, and associated patient outcomes.
Methods This study uses data collected for the National Oesophago Gastric Cancer Audit (NOGCA), and compares patients diagnosed in the year following 1st April 2008 (Group 1), with those diagnosed five years later in 2013 (Group 2). The study was limited to patients diagnosed with early stage (T0/1, N0, M0) oesophageal adenocarcinoma.
Outcomes considered included proportion of patients managed with curative intent, curative treatment modality and patient outcomes at 1 year.
Results A similar number of patients were diagnosed with early stage cancer over both time frames, Group 1 (n = 202) and Group 2 (n = 193). The proportion of patients managed with curative intent increased over the five years from 77.4% to 83.4% (chi-square test, p = 0.13). However the proportion of patients aged ≥75 years managed with curative intent increased significantly between 2008 and 2013, from 48% to 67% (p = 0.02).
These increases are likely to reflect changes in curative treatment modalities. Over the last five years, there has been a significant increase in the proportion of patients managed with less invasive curative treatment modalities, with the proportion being managed endoscopically increasing from 18% to 34%, while there was a corresponding decrease in the proportion managed surgically from 76% to 61% (p = 0.007).
Patients diagnosed with early cancer in 2013 who were managed with curative intent were significantly more likely to survive 1 year than those who had been diagnosed in 2008 (98% vs 93%, p = 0.05).
Conclusion Outcomes for patients diagnosed with early oesophageal adenocarcinomas have improved over the last five years. Over the same period, the proportion of patients managed with less invasive endoscopic treatment modalities has increased significantly. However, it should be noted that a sizeable minority of patients are still being managed with palliative intent. The NOGCA will continue to monitor the management of this group of patients in future.
References 1 Chadwick G, et al. Management and survival of patients with early stage oesophageal adenocarcinomas in England: a population-based cohort study. British Journal of Surgery.
2 Wani S, et al. Comparison of endoscopic therapies and surgical resection in patients with early esophageal cancer: a population-based study. Gastrointest Endosc. 2014;79(2):224–32.e1.
Disclosure of Interest None Declared
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