Elsevier

Gastrointestinal Endoscopy

Volume 42, Issue 6, December 1995, Pages 501-506
Gastrointestinal Endoscopy

Prognosis of esophageal cancers preoperatively staged to be locally invasive (T4) by endoscopic ultrasound (EUS): a multicenter retrospective cohort study,☆☆,

Presented in part at the Digestive Disease Week, 1994, New Orleans, Louisiana, and at the World Congress of Gastroenterology, 1994, Los Angeles, California.
https://doi.org/10.1016/S0016-5107(95)70001-3Get rights and content

Abstract

Background: Endosonography is a significant advance in the preoperative staging (TNM classification) of esophageal cancer. Its accuracy for evaluating depth of tumor invasion is over 80%.

Methods: A multicenter retrospective cohort study of patients with esophageal carcinomas defined to be invasive (T4) by endosonography was performed to compare the survival of surgically and nonsurgically treated patients. Median survival time, overall mortality, and Kaplan-Meier survival curves were compared by treatment group. Univariate and Cox regression analysis were used to evaluate the effects of various prognostic factors and treatment on the risk of death.

Results: A total of 79 patients were studied. The surgical group (Group I, n = 42) was significantly younger and had more distal tumors (adenocarcinomas) than the nonsurgical group (Group II, n = 37). Endosonography was significantly more accurate than CT scanning in identifying tumor invasion (87.5% versus 43.8%, respectively, p = .0002). Overall mortality rate was not significantly different between treatment groups; 59.5% of the surgical group and 64.9% of the nonsurgical group were dead at follow-up ( p = 0.65). Similarly, the median survival times of Group I and Group II patients were similar (5.2 and 7.0 months, respectively, p = 0.50). Survival curves for the two groups were almost overlapping (log rank test, p = 0.84). Even after adjusting for age, histologic diagnosis, tumor location, and regional lymph node status, surgical treatment did not significantly influence survival ( p = 0.24).

Conclusions: Endosonography accurately identifies patients with invasive T4 tumors who have a poor prognosis. This prognosis is independent of mode of therapy. (Gastrointest Endosc 1995;42:501-6.)

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.

☆☆

Reprint requests: Amitabh Chak, MD, University Hospitals of Cleveland, 11100 Euclid Ave, Cleveland, Ohio, 44106-5066.

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