The Long-Term Outcomes of Surgery Versus Endoscopic Treatment in Patients With Siewert Type II T1M0N0 Adenocarcinoma of the Esophagogastric Junction

Abstract

Objective We compared the long-term prognosis of surgery and endoscopic treatment (ET) in patients diagnosed with Siewert Type II pT1N0M0 adenocarcinoma of the esophagogastric junction (AEG). Methods Using the Surveillance, Epidemiology, and End Results (SEER) database, we performed a real-world retrospective cohort study and enrolled patients with Siewert Type II pT1N0M0 AEG who underwent surgery or endoscopic treatment (ET) from 2010 to 2018. Matched cohorts were generated using propensity score matching Competing-risk analysis was applied. The cumulative incidence function was used to calculate cancer-specific death and other causes of death (OCD) at different time points. Univariate and multivariate analyses were performed to identify significant prognostic factors by using the subdistribution hazard ratio Results We enrolled 725 patients: 462 underwent surgery and 263 received ET. The 5 year cumulative CSD incidence significantly differed between surgery and ET cohorts (16.87% vs 11.08%, P = .01). Following PSM, 2 balanced groups (n = 219 patients each) were analyzed. No significant difference in the 5 year cumulative incidences of CSD was noted between cohorts (17.61% vs. 12.16%, P = .14 ). In multivariable analysis, the CSD incidence was high among patients with aged ≥65 (SHR 2.29, 95%CI 0.99-5.33, P = .05 ) and T1b-stage (SHR 1.92, 95%CI 1.03-3.57, P = .04 ); treatment (surgery or ET) was not significantly associated with cancer survival (SHR 1.51, 95% CI 0.81-2.81, P = .20 ). Conclusion Long-term survival did not significantly differ among patients with Siewert Type II pT1N0M0 AEG adenocarcinoma undergoing surgery or ET. ET may be considered in patients >65 years old or those with submucosal (T1b-stage) cancer of AEG.