Tu1199 COMPARISON OF THE SUCCESS OF ENDOSCOPIC TREATMENT IN EARLY ESOPHAGEAL SQUAMOUS CELL CANCER AND ESOPHAGEAL ADENOCARCINOMA. A NINE YEARS EXPERIENCE FROM A CANCER HOSPITAL

Abstract

Endoscopic treatment of early esophageal adenocarcinoma EAC (T1a) with EMR and RFA is considered the standard of care. The role of endoscopic therapy of early Esophageal Squamous cell carcinoma (SCC) is not well established. To compare the success of endoscopic treatment of early SCCA to that of EAC We reviewed medical records of patients with esophageal SCC who underwent endoscopic treatments with RFA, EMR, and/or cryotherapy between 1/1/2008 and 8/31/2017. Patients were excluded if they were Stage 2 or higher, had received chemoradiation or surgery. 131 EAC and 13 SCC were identified. (Table 1). All patients had post treatment biopsies. Success was defined as the absence of cancer or high grade dysplasia in the biopsy specimen after completion of endoscopic treatment. Kaplan-Meier analysis was used to assess for overall survival and time to success among the two groups. Significantly more women were in the SCC group n=9 (64.3%) compared to EAC n=16 (11.4%), p<0.001). SCC patients achieved success after a significantly fewer EMR procedures n=7 (53.8%) than EAC n=134 (96.9%) p<0.001. The mean duration of RFA treatment was significantly longer in SCC vs. EAC patients (20.4 months vs, 10.3 months, P=0.009). Success was achieved in 11 (84.6%) SCC compared to 127 (96.9%) EAC. Median time to success was similar in both groups: 11.4 months for SCC (CI: 10.3-13.1) 11 months in EAC (CI: 7.7, 16.4). Follow-up duration was longer in SCC vs. EAC group (mean: 54.6 vs 37.6 months, respectively, p=0.037). After a mean follow up duration of 27 months, SCC had significantly higher rate of recurrence n=3(25%) compared to EAC n=6 (4.6%), p=0.029. 17 (11.8%). The SCC recurrences were in patients with carcinoma in situ. None had LVI. Treatment related complications: 15 (10.4%) post EMR strictures, 2 (1.4%) bleeding, 1 (0.7%) perforation. The complication rate was comparable in both groups (p=0.117). Overall survival was similar among the two groups (EAC: 14/131 death, SCC: 1/14 death, p=0.74). The success rate of endoscopic treatment was similar among patients with early esophageal SCC and EAC. However the SCC cohort required significantly more RFA and had a higher rate of recurrence compared to the EAC cohort. Only highly selected SCC patients should undergo endoscopic treatment.Table 1Tumor and treatment characteristicsItemAdenocarcinomaSquamous cell carcinomaP-valueN= 131N= 13Tumor stage n (%):<0.001Stage T1a100 (76.3)2 (15.4)Stage T1b31 (23.7)2 (15.4)In situ Tis0 (0)9 (69.2)Multifocal tumor15 (11.5)2 (15.4)0.653Lymphovascular invasion n (%)4 (3.1)1 (7.7)0.290Length of RFA treatment in months mean (SD)10.3 (12.7)20.4 (20.6)0.009EMR n (%)127 (96.9)7 (53.8)<0.001Cryotherapy n (%)7 (5.3)3 (23.1)0.048Complications n (%)14 (10.7)3 (23.1)0.117Length of follow-up in months mean (SD)37.6 (22.3)54.6 (22.1)0.016Success n (%)127 (96.9)11 (84.6)0.092Recurrence n (%)6 (4.6)3 (25)0.029EMR: endoscopic mucosal resection Open table in a new tab