S0344 Endoscopic Resection of T1b Esophageal Adenocarcinoma Is Comparable to Esophagectomy: A Surveillance, Epidemiology, and End Results Database Study
Bibliographic record
Abstract
INTRODUCTION: Current guidelines recommend consideration of endoscopic therapy when treating T1a esophageal adenocarcinoma. However, it remains unclear if endoscopy is appropriate for treating T1b lesions with and without lymph node metastasis. Our study aims to compare survival outcomes following surgical resection and endoscopy in treating T1b esophageal adenocarcinoma. METHODS: We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results database from 2000 to 2016 of patients with T1b esophageal adenocarcinoma treated with endoscopic resection or esophagectomy. Kaplan Meier estimations and cox proportional hazards models were used to assess survival outcomes. RESULTS: A total of 603 patients with T1b esophageal carcinoma were identified, of whom 87.7% were male. Median age at diagnosis was 67 ± 10.6 years. Overall, males had a higher prevalence of T1b esophageal carcinoma compared to females (87.7% vs. 12.1 per 100,000 per year). Tumors were most common among White patients (95.2%). Most tumors were moderately differentiated (45%), followed by poorly differentiated (33%), well differentiated (10.4%), and undifferentiated (1.0%). Most tumors occurred in the distal third of the esophagus (83.4%) followed by the mid esophagus (8.6%) and the proximal third (1.8%). About 84 (13.9%) underwent endoscopic resection and 367 (60.9%) underwent esophagectomy. One, 3- and 5-year survival for cancer-specific death was associated with survival rates of 91%, 78%, and 74%, respectively, for endoscopic resection. Esophagectomy was associated with 1-, 3 and 5-year survival rates of 91%, 85%, and 73%, respectively. Subgroup analysis showed that in patients with lymph node metastasis (LMN), no significant difference in mortality was observed following surgical and endoscopic resection (Log Rank test = 0.903). Adjusted hazard models indicated that LMN was associated with 2 times higher mortality [HR 2.16, 95% CI 1.250-23.742, P = 0.0.006], and surgical intervention was associated with a non-significant reduction in mortality [HR 0.78, 95% CI 0.414-1.480, P = 0.451]. CONCLUSION: Endoscopic resection was associated with similar cancer-specific survival outcomes compared with esophagectomy in stage T1b esophageal adenocarcinoma, regardless of lymph node metastasis. Endoscopic removal of T1b esophageal adenocarcinoma is an effective strategy for patients including those either refusing esophagectomy or not a candidate for surgical intervention.Figure 1.: Survival following endoscopic resection (ER) and surgical resection (SR).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".