Treatment disparities affect outcomes for patients with stage I esophageal cancer: a national cancer data base analysis

Journal of Gastrointestinal Oncology
Amy C MorenoSteven H Lin

Abstract

To examine patterns of care and outcomes for patients with stage I esophageal cancer (EC) in the United States. We identified patients in the National Cancer Data Base diagnosed with stage I EC from 2004 to 2012 and grouped them by primary treatment: esophagectomy (Eso), local excision (LE), concurrent chemoradiation (CRT), or observation (Obs). Multinomial logistic regression was used to predict receipt of treatments. Overall survival (OS) was estimated by Kaplan-Meier methods adjusted for inverse probability of treatment weighting (IPTW) and Cox proportional hazard regressions. Of 5,480 patients, 2,312 (42%) underwent Eso, 1,250 (23%) LE, 758 (14%) CRT, and 1,160 (21%) Obs. LE use increased over time from 17% to 29% while Obs declined from 26% to 19%. Patients least likely to undergo surgery were older, had greater comorbidity, were uninsured, were treated at non-academic centers, and were Black. The rate of surgery for Black patients was half of that for White patients (33% vs. 67%). Postoperative mortality rates were higher after Eso vs. LE at 30 days (2.9% vs. 0.5%; P<0.001) and at 90 days (5.5% vs. 1.4%, P<0.001). Five-year OS was 59% with Eso, 63% LE, 29% CRT, and 31% Obs (P<0.001). On multivariate analysis, outcomes wer...Continue Reading

Citations

May 19, 2021·Cancer Causes & Control : CCC·Edgar CoronaFolasade P May
Jul 29, 2021·Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus·Li-Xiang MeiMing-Wu Chen

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