Premium
Endoscopic ultrasonography in esophageal cancer leads to improved survival rates: Results from a population‐based study
Author(s) -
Wani Sachin,
Das Ananya,
Rastogi Amit,
Drahos Jennifer,
Ricker Winifred,
Parsons Ruth,
Bansal Ajay,
Yen Roy,
Hosford Lindsay,
Jankowski Meghan,
Sharma Prateek,
Cook Michael B.
Publication year - 2015
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.29043
Subject(s) - medicine , endoscopic ultrasound , hazard ratio , esophageal cancer , confidence interval , proportional hazards model , esophagectomy , positron emission tomography , survival analysis , nuclear medicine , population , survival rate , radiology , log rank test , cancer , environmental health
BACKGROUND The advantages of endoscopic ultrasound (EUS) and computed tomography (CT)–positron emission tomography (PET) with respect to survival for esophageal cancer patients are unclear. This study aimed to assess the effects of EUS, CT‐PET, and their combination on overall survival with respect to cases not receiving these procedures. METHODS Patients who were ≥66 years old when diagnosed with esophageal cancer were identified in the Surveillance, Epidemiology, and End Results–Medicare linked database. Cases were split into 4 analytic groups: EUS only (n = 318), CT‐PET only (n = 853), EUS+CT‐PET (n = 189), and no EUS or CT‐PET (n = 2439). Survival times were estimated with the Kaplan‐Meier method and were compared with the log‐rank test for each group versus the no EUS or CT‐PET group. Multivariate Cox proportional hazards models were used to compare 1‐, 3‐, and 5‐year survival rates. RESULTS Kaplan‐Meier analyses showed that EUS, CT‐PET, and EUS+CT‐PET patients had improved survival for all stages (with the exception of stage 0 disease) in comparison with patients undergoing no EUS or CT‐PET. Receipt of EUS increased the likelihood of receiving endoscopic therapies, esophagectomy, and chemoradiation. Multivariate Cox proportional hazards models showed that receipt of EUS was a significant predictor of improved 1‐ (hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.39‐0.59; P < .0001), 3‐ (HR, 0.57; 95% CI, 0.48‐0.66; P < .0001), and 5‐year survival (HR, 0.59; 95% CI, 0.50‐0.68). Similar results were noted when the results were stratified on the basis of histology and for the CT‐PET and EUS+CT‐PET groups. CONCLUSIONS Receipt of either EUS or CT‐PET alone in esophageal cancer patients was associated with improved 1‐, 3‐, and 5‐year survival. Future studies should identify barriers to the dissemination of these staging modalities. Cancer 2015;121:194–201 . © 2014 American Cancer Society .