Comparison of LNM and survival in T1 stage esophageal cancer patients based on histological classification: A large population-based study

Abstract

Limited evidence and contradictory results have been reported regarding the impact of squamous cell carcinoma (SCC) and adenocarcinoma (AC) classification on lymph node metastasis (LNM) and prognosis in esophageal cancer (EC). We aimed to compare 2 histology types in terms of LNM and prognosis using a comprehensive statistical analysis of a large population. The Surveillance, Epidemiology, and End Results (SEER) database was used to extract patient information. Univariate and multivariate logistic or Cox regression, a multivariate competing risk model and propensity score matching (PSM) were used to explore the association between LNM or survival and the 2 histology types. Information for 4764 patients, including 1712 SCC and 3052 AC patients, was extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate logistic regression analysis revealed a correlation between LNM and histology (odds ratio [OR] = 0.654, P = .037). We found that patients with AC had a better prognosis than SCC patients through both the multivariate Cox regression (hazard ratio [HR] = 0.866) and the multivariate competing risk model (subdistribution hazard ratio [SHR] = 0.704). However, no positive relation was found between LNM and histology type (P = .844) based on propensity score matching (PSM), and the prognosis remained poorer for the patients with SCC (P < .001). T1-stage EC with a histology of SCC may have a comparable risk of LNM as the AC type, while SCC has a poorer prognosis than the AC type.