The prognosis of esophageal carcinoma staged irresectable (T4) by endosonography

Background: Endosonography is an accurate preoperative staging technique for esophageal carcinoma. We retrospectively investigated a cohort of patients with carcinoma of the esophagus or gastric cardia that was endosonographically staged to be irresectable and studied whether their survival was influenced by the treatment received. Study Design: Between April 1992 and July 1995, 654 patients were referred for endosonographic staging. We retrospectively searched our database for patients staged T4 and collected followup. Kaplan-Meier survival and Cox proportional hazards model were used to study the effect of treatment and various other factors on survival. Results: Fifty-one patients (median age, 62 years; range, 44-87; 37 male) were staged T4 by endosonography. Followup was collected of all patients. Explorative surgery was chosen in 24 patients (47%), and the tumor was resected in 13 patients. Median survival in the surgical group was 9.67 months (95% confidence interval [CI] 6.03, 13.31) and 7.06 months (95% CI: 5.68, 8.44) in the nonsurgical group (not significant). Patients with infiltration in the respiratory tract had a 2.5 times higher risk of death than patients without (adjusted hazard ratio: 2.54; 95% CI: 1.30, 4.96). Conclusions: Patients staged irresectable by endosonography (T4 stage) have a very poor prognosis, regardless of further therapy. Survival of this group of patients was not influenced by surgery. (C) 1998 by the American College of Surgeons.