Analysis in prognosis of surgical operation versus endoscopic therapy in treating patients with early esophageal adenocarcinoma based on SEER database

  Objective  To analyze the influence of endoscopic and surgical treatments on the prognosis of early esophageal adenocarcinoma (eEA) patients with tumor invasion depth of muscularis mucosa (M3) and submucosa (SM) based on the cancer registry database of American Surveillance, Epidemiology, and End Results (SEER).

  Methods  We searched and downloaded esophageal cancer data from 2004 to 2015 in SEER database. The data screened by inclusion and exclusion criteria were divided into endoscopic group and surgical group according to different treatment methods. The variables with statistical differences in general data in both groups were used as matching variables to make the tendency evaluation matching (PSM) for balance the differences between the two groups. For the final data after PSM, the median lifetime and 1-, 3-, 5-year survival rates were calculated by the life table method, the Kaplan-Meier was used to calculate and draw survival curve, and Log-rank test was used to evaluate the survival difference between the two groups after the stratified treatment of each covariate. The Cox regression model was used for univariate and multivariate analysis.

  Results  There was no significant difference in overall survival curve between the endoscopic group and the surgical group (P=0.545). After stratified processing of age, gender, tumor location, clinical staging, T staging and degree of differentiation, there was a significant difference in survival rate in people aged 80 and above between the endoscopic group and the surgical group (P=0.038). Univariate Cox analysis showed that age (HR=2.147, 95%CI, 1.590 to 2.900, P < 0.001) and T staging (HR=2.020, 95%CI, 1.328 to 3.074, P < 0.001) were significantly correlated with the prognosis of patients with eEA. Multivariate Cox analysis showed that age (HR=2.000, 95%CI, 1.480 to 2.704, P < 0.001) and T staging (HR=1.767, 95%CI, 1.155 to 2.703, P=0.009) were independent risk factors for the prognosis of patients with eEA.

  Conclusion  For eEA patients with invasion depth of M3 and SM, endoscopic treatment can achieve the same prognosis as surgical treatment. If lymph node and distant metastasis are excluded before operation, endoscopic treatment is recommended at first. It is suggested that eEA patients aged 80 and above should be treated with endoscopy, and senile and T1b stage eEA cases should be given additional postoperative chemoradiotherapy.