Critical appraisal:Crabtree TD, Yacoub WN, Puri V, Azar R, Zoole JB, Patterson GA, et al 2011

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Critical Appraisal

Article being appraised

Crabtree TD, Yacoub WN, Puri V, Azar R, Zoole JB, Patterson GA, et al. Endoscopic ultrasound for early stage esophageal adenocarcinoma: implications for staging and survival. Ann Thorac Surg 2011 May;91(5):1509-15; discussion 1515-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21435632.


Applicable clinical question

Key Facts

Study Design

case series

Number of Patients:

149


Includes an economic evaluation

no

Evidence ratings

Level of evidence

IV

Risk of bias
High risk of bias Comments: Please replace this text and include any additional comments in regards to your quality rating

Risk of bias assessment: case series

Subject selection:
Highly selected or not described (e.g. single-institution study)
Were the outcome measures blind to pre/post-intervention?
No, but objective measures used
Follow-up complete and all patients included in the analysis?
Yes (follow-up >95%)
Size of effect
5 Reason for decision: Please replace this text and briefly describe the reasons for your rating
Relevance of evidence
1 Additional comments: Please replace this text and briefly describe the reasons for your rating
Result of appraisal

Jutta's tick icon.png Included



Comments

This is a retrospective, single-centre case series of 149 patients who underwent EUS and oesophagectomy for adenocarcinoma. Of 25 patients with clinical T1N0 and 18 patients with T2N0 disease at EUS, pathologic nodal disease was present in 6 (24%) and 7 (38.8%) respectively at resection. Among the 18 cases of cT2N0 disease, 9 (50%) were pathologically staged as T1N0, 8 (44%) were upstaged to pT3N0-1, and 1 (6%) was
pT2N0. One case of cT1N0 tumor (4%) was upstaged to pT3N0. Among patients with cT1-2N0 tumors, 5-year disease-free survival for the group that was appropriately staged was 89.8% versus 39.9% for the group that had a higher pathologic stage than their clinical stage (i.e. >T2N0) (p <0.001). Multivariate analysis identified marked/intense uptake on staging PET (odds ratio, 5.76, 95%; confidence interval,1.25 to 26.52; p=0.021) to be a factor predictive of upstaging of cT1-2N0 tumors.

Completed by

Dr Jeremy Dwyer MBBS (Hons)


Jutta's tick icon.png This appraisal has been completed.


Article
Crabtree TD, Yacoub WN, Puri V, Azar R, Zoole JB, Patterson GA, et al. Endoscopic ultrasound for early stage esophageal adenocarcinoma: implications for staging and survival. Ann Thorac Surg 2011 May;91(5):1509-15; discussion 1515-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21435632.
Assigned to
User:Alan.moss
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


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