Value of endoscopic ultrasonography as a predictor of long-term survival in oesophageal carcinoma

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Abstract
Background Endoscopic ultrasonography (EUS) is considered to be the best locoregional staging technique for cancer of the oesophagus. This study evaluated the relationship between preoperative EUS findings, completeness of surgical resection and survival. Methods Between January 1995 and July 2002, 150 patients who underwent EUS for staging of tumours of the oesophagus were analysed prospectively. All underwent surgical resection with curative intent without neoadjuvant treatment. Results Patient survival was significantly related to tumour (EUS T), node (EUS N) and Union Internacional Contra la Cancrum classification (EUS UICC) stage according to sonographic findings (P = 0·003, P = 0·009 and P = 0·004 respectively), and the presence of stenosis determined by EUS (P = 0·004). EUS T stage was a prognostic factor for survival (relative risk 1·7 (95 per cent confidence interval (c.i.) 1·1 to 3·0); P = 0·046). Complete surgical resection (R0) was also significantly related to EUS T, N and UICC classification (P < 0·001). EUS UICC stage was a factor predictive of R0 resection (relative risk 2·6 (95 per cent c.i. 1·4 to 4·8); P = 0·003). Conclusion R0 resection and survival of patients with tumours of the oesophagus were strongly related to endosonographic findings. These results support the proposal that EUS should be performed in all patients with oesophageal cancer, not only for staging patients before therapy but also to determine prognosis.