Prognosis of esophageal cancers preoperatively staged to be locally invasive (T4) by endoscopic ultrasound (EUS): a multicenter retrospective cohort study☆,☆☆,★
Section snippets
PATIENTS AND METHODS
Endosonography reports of patients with esophageal cancer were reviewed retrospectively to identify patients. Patients were included in the study if they had (1) biopsy-proven esophageal carcinoma of the esophagus, (2) EUS performed at one of five major medical centers between 1988 and 1993 (all five centers had extensive experience with EUS), (3) no evidence of distant metastases on abdominal and chest CT, chest radiographs, or bone scan, and (4) had endosonographic evidence of regional organ
Patient characteristics
A total of 79 patients (56 men, 23 women) with a mean age of 63.5 (range 31 to 86 years) fulfilled the study criteria and were included in the study. Group I consisted of 42 patients who underwent attempted surgical resection, often as part of a multimodality treatment protocol. Group II consisted of 37 patients who received only nonsurgical therapy, i.e., radiotherapy, chemotherapy, esophageal dilation, prosthesis placement, or laser ablation. Forty-one patients (52%) had adenocarcinomas, and
DISCUSSION
EUS is the most accurate nonoperative technique for determining the depth of tumor infiltration in patients with esophageal cancer. Hence, it is accurate in predicting which patients will be able to undergo complete resection (no macroscopic or microscopic tumor remains).17 EUS is being used for tumor staging to guide treatment decisions in patients with esophageal cancer,17, 18 although benefit to patients remains unproven.
We found that the majority of patients with esophageal EUS T4
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From the Division of Gastroenterology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Gastroenterology Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Division of Gastroenterology, Columbia Presbyterian Medical Center, New York, New York; Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana; Division of Gastroenterology, Georgetown University Medical Center, Washington, D.C.; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio; and Center for Swallowing Disorders, University of South Florida College of Medicine, Tampa, Florida.
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Reprint requests: Amitabh Chak, MD, University Hospitals of Cleveland, 11100 Euclid Ave, Cleveland, Ohio, 44106-5066.
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