Endoscopic ultrasonography in esophageal cancer leads to improved survival rates: results from a population-based study

Cancer. 2015 Jan 15;121(2):194-201. doi: 10.1002/cncr.29043. Epub 2014 Sep 18.

Abstract

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.

Keywords: endoscopic ultrasonography; endoscopic ultrasound; esophageal cancer; positron emission tomography and computed tomography; staging; survival.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / diagnostic imaging
  • Adenocarcinoma / mortality
  • Adult
  • Aged
  • Carcinoma, Squamous Cell / diagnostic imaging
  • Carcinoma, Squamous Cell / mortality
  • Endosonography*
  • Esophageal Neoplasms / diagnosis
  • Esophageal Neoplasms / diagnostic imaging*
  • Esophageal Neoplasms / mortality*
  • Esophageal Neoplasms / pathology
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Medicare
  • Middle Aged
  • Multimodal Imaging / methods*
  • Neoplasm Staging
  • Positron-Emission Tomography*
  • Proportional Hazards Models
  • SEER Program
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed*
  • United States / epidemiology