Clinical outcomes of T1 esophageal carcinoma as staged by EUS: A multicenter evaluation

Background: Patients with T1 esophageal cancer may require less aggressive treatment (EMR, PDT, or immediate resection without neoadjuvant therapy). Patients with T2 lesions have better outcomes when given pre-operative as opposed to post-operative neoadjuvant therapy, emphasizing the importance of accurate staging. We investigated patients in whom EUS indicated T1 disease. Methods: All pre-therapeutic EUS examinations for esophageal cancer were reviewed. Chart reviews were conducted on all patients endosonographically staged as T1. The accuracy of EUS staging was determined in those patients resected without intervening chemoradiation. Results: 56 pts were identified as having a T1 tumor (7% of all eligible exams). 82% were male and mean age was 66 yrs. 82% were adenocarcinomas. Mean follow-up was 22 mo. Staging was performed predominantly with radial echoendoscopes (4 staged with high-frequency probes and 10 with linear array). Treatment was as follows: surgical resection 79%, neoadjuvant + resection 5%. EMR 5%, PDT 4%, neoadjuvant alone 2%, with 5% awaiting resection. Surgical Pathology: T1 - 39 T2 = 42 T3 = 2 N0 = 36 N1 = 3 EUS Accuracy: T = 87% N = 95% Post-Tx Recurrence: Mortality (avg 22 mo) 2/56 (3.6%)-pathological stage T1N1 and T1N0 8 (14%) 3 post-op, 1 cancer, 2 unrelated, 2 unknown Conclusions: EUS staging accuracy for T1 tumors was 87% as compared with surgical stage. Post-operative recurrence and cancer-related mortality are uncommon. Whether limitations in EUS staging of T1 tumors adversely effects clinical outcome could not be determined, although previous series have suggested improved outcomes with pre-op neoadjuvant therapy for T2 tumors. Even when accurately staged as T1, nodal metastases may be present at resection limiting the efficacy of endoscopic therapy. The potential to improve T-staging accuracy in early lesions via high frequency (20 MHz) endosonography needs to be addressed.