In an analysis of 9-year outcomes of a Chinese trial (ESECC) reported in the Journal of Clinical Oncology, Liu et al found that endoscopic screening for esophageal cancer was associated with numeric benefit vs no screening in terms of the incidence of esophageal cancer and esophageal cancer–related mortality.
Study Details
The study included residents aged 45 to 69 years in a high-risk region for esophageal squamous cell carcinoma in northern China recruited between January 2012 and September 2016. A total of 668 villages were randomly assigned to be offered one-time chromoendoscopic screening or not offered endoscopic screening. Participants in the endoscopy group with iodine-unstained lesions or pathologic-confirmed mild or moderate dysplasia at baseline examination were invited to undergo a surveillance chromoendoscopy at a median of 4.4 years after index endoscopy. The primary outcome measures were incidence of esophageal cancer and esophageal cancer–related mortality.
Key Findings
A total of 33,847 participants were included in the analysis, including 17,104 in the screening group and 16,743 in the control group; in the screening group, 15,165 participants (88.7%) underwent screening.
During a maximum follow-up of 9 years, intention-to-treat (ITT) analysis showed that esophageal cancer incidence in the screening group vs the control group was 60.9 vs 72.5 per 100,000 person-years (adjusted hazard ratio [HR] = 0.81, 95% confidence interval [CI] = 0.60–1.09). Esophageal cancer mortality was 29.7 vs 32.4/100,000 person-years (adjusted HR = 0.82, 95% CI= 0.53–1.26).
In per-protocol analysis, esophageal cancer incidence was 57.2 vs 72.5/100,000 person-years (adjusted HR = 0.78, 95% CI = 0.56–1.10) and esophageal cancer mortality was 28.5 vs 32.4/100,000 person-years (adjusted HR = 0.79, 95% CI = 0.49–1.30).
The investigators concluded, “With a 9-year follow-up, our trial suggests that chromoendoscopic screening induces modest reductions in esophageal cancer incidence and mortality. A more efficient strategy for esophageal cancer screening and subsequent patient management should be established to guarantee the effectiveness of endoscopic screening.”
Zhonghu He, PhD, of Beijing Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the Charity Project of the National Ministry of Health, Natural Science Foundation of China, and others. For full disclosures of the study authors, visit ascopubs.org.
