Adjuvant strategies for patients with T1b invasion after endoscopic submucosal dissection for esophageal squamous cell carcinoma

doi:10.3969/j.issn.1674-8115.2024.01.013

Abstract

Abstract:

Objective ·To compare the prognostic effects of radical resection of esophageal cancer, concurrent chemoradiotherapy and simple follow-up observation on the prognosis of patients with T1b invasion of superficial esophageal squamous cell carcinoma after endoscopic submucosal dissection (ESD). Methods ·From May 2016 to May 2021, the clinical data of 67 patients with esophageal squamous cell carcinoma who were pathologically confirmed as pT1b after ESD and treated in Shanghai Chest Hospital were retrospectively analyzed. According to the additional treatment after ESD, the patients were divided into additional surgery group (S group), chemoradio-therapy group (CRT group) and observation group (O group). χ² test was used to compare the clinical baseline data and pathological information of the three groups of patients. The Kaplan-Meier survival curve and log-rank test were used to compare the disease free survival (DFS) and recurrence free survival (RFS) of the three groups of patients, and the Cox proportional hazards regression model was used on DFS and RFS by univariate and multivariate analysis. Results ·Among all 67 patients, there were 23 cases in the S group, 19 cases in the CRT group, and 25 cases in the O group. There was no significant difference in age (P=0.080), gender (P=0.078), tumor length (P=0.485), tumor location (P=0.655), lesion circumferential ratio (P=0.310), histological grading (P=0.084), depth of tumor invasion (P=0.066) and lymphovascular invasion (P=0.279) among the three groups. During (42.6±16.7) months of follow-up, tumor recurrence was observed in 10 cases (14.9%), including 6 patients (60%) with local recurrence, 2 patients (20%) with regional lymph recurrence and 2 patients (20%) with distant metastasis. The median recurrence time of group S, group CRT, and group O was 40.1, 36.6, and 22.1 months, and the 3-year DFSs were 100%, 89.5%, and 74.5% (P-trend=0.040). Multivariate Cox analysis showed that additional esophagectomy was the key to improving independent protective factors of RFS (HR=0.097, 95%CI 0.010?0.956, P=0.046). Conclusion ·For patients with superficial esophageal squamous cell carcinoma confirmed as pT1b after ESD, additional surgery can significantly reduce the possibility of long-term recurrence.

Key words: superficial esophageal cancer, esophageal squamous cell carcinoma, pathology stage, endoscopic submucosal dissection, additional treatment

CLC Number:

R735.1

ZHU Kaiyuan, SU Yuchen, LIU Zhichao, ZHANG Hong, LI Chunguang, ZHANG Jie, LI Zhigang. Adjuvant strategies for patients with T1b invasion after endoscopic submucosal dissection for esophageal squamous cell carcinoma[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(1): 116-123.

Figures/Tables 2

TrendMD

References 35

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Characteristic	Total	S group	CRT group	O group	P value
Characteristic	(n=67)	(n=23)	(n=19)	(n=25)	P value
Age/years	65.3±7.4	63.1±4.9	64.4±5.5	68.1±9.5	0.080
Gender/n(%)					0.078
Male	54 (80.6)	22 (95.7)	14 (73.7)	18 (72.0)
Female	13 (19.4)	1 (4.3)	5 (26.3)	7 (28.0)
Smoking history/n(%)					0.213
None	22 (32.8)	5 (21.7)	6 (31.6)	11 (44.0)
Yes	39 (58.2)	17 (73.9)	10 (52.6)	12 (48.0)
Unknown^①	6 (9.0)	1 (4.3)	3 (15.8)	2 (8.0)
Alcohol history/n(%)					0.834
None	28 (41.8)	9 (39.1)	8 (42.1)	11 (44.0)
Yes	33 (49.2)	13 (56.5)	8 (42.1)	12 (48.0)
Unknown^①	6 (9.0)	1 (4.3)	3 (15.8)	2 (8.0)
Tumor length/cm	3.7±2.1	4.2±2.6	3.1±1.1	3.7±2.1	0.485
Tumor location/n(%)					0.655
Upper	6 (9.0)	2 (8.7)	3 (15.8)	1 (4.0)
Middle	26 (38.8)	9 (39.1)	8 (42.1)	9 (36.0)
Lower	35 (52.2)	12 (52.2)	8 (42.1)	15 (60.0)
Lesion circumferential ratio/n(%)					0.310
<0.50	20 (29.9)	5 (21.7)	8 (42.1)	7 (28.0)
≥0.50 and<0.75	31 (46.3)	13 (56.5)	9 (47.4)	9 (36.0)
≥0.75	12 (17.9)	5 (21.7)	1 (5.3)	6 (24.0)
Unknown^①	4 (6.0)	0 (0)	1 (5.3)	3 (12.0)
Histological grading/n(%)					0.084
G1	14 (20.9)	5 (21.7)	4 (21.1)	5 (20.0)
G2	29 (43.3)	5 (21.7)	9 (47.4)	15 (60.0)
G3	14 (20.9)	9 (39.1)	2 (10.5)	3 (12.0)
Gx	10 (14.9)	4 (17.4)	4 (21.1)	2 (8.0)
Pathology T stage after ESD/n(%)					0.066
pT1b-SM1	28 (41.8)	7 (30.4)	6 (31.6)	15 (60.0)
pT1b-SM2	39 (58.2)	16 (69.6)	13 (68.4)	10 (40.0)
Vertical margin/n(%)					0.075
Positive	18 (26.9)	9 (39.1)	6 (31.6)	3 (12)
Negative	48 (71.6)	13 (56.5)	13 (68.4)	22 (88)
Unknown^①	1 (1.5)	1 (4.3)	0 (0)	0 (0)
Horizontal margin/n(%)					0.814
Positive	21 (31.3)	6 (26.1)	6 (31.6)	9 (36.0)
Negative	45 (67.2)	16 (69.6)	13 (68.4)	16 (64.0)
Unknown^①	1 (1.5)	1 (4.3)	0 (0)	0 (0)
Lymphovascular invasion/n(%)					0.279
Positive	7 (10.4)	4 (17.4)	2 (10.5)	1 (4.0)
Negative	57 (85.1)	17 (73.9)	17 (89.5)	23 (92.0)
Unknown^①	3 (4.5)	2 (8.7)	0 (0)	1 (4.0)

Characteristic	Total	S group	CRT group	O group	P value
Characteristic	(n=67)	(n=23)	(n=19)	(n=25)	P value
Age/years	65.3±7.4	63.1±4.9	64.4±5.5	68.1±9.5	0.080
Gender/n(%)					0.078
Male	54 (80.6)	22 (95.7)	14 (73.7)	18 (72.0)
Female	13 (19.4)	1 (4.3)	5 (26.3)	7 (28.0)
Smoking history/n(%)					0.213
None	22 (32.8)	5 (21.7)	6 (31.6)	11 (44.0)
Yes	39 (58.2)	17 (73.9)	10 (52.6)	12 (48.0)
Unknown^①	6 (9.0)	1 (4.3)	3 (15.8)	2 (8.0)
Alcohol history/n(%)					0.834
None	28 (41.8)	9 (39.1)	8 (42.1)	11 (44.0)
Yes	33 (49.2)	13 (56.5)	8 (42.1)	12 (48.0)
Unknown^①	6 (9.0)	1 (4.3)	3 (15.8)	2 (8.0)
Tumor length/cm	3.7±2.1	4.2±2.6	3.1±1.1	3.7±2.1	0.485
Tumor location/n(%)					0.655
Upper	6 (9.0)	2 (8.7)	3 (15.8)	1 (4.0)
Middle	26 (38.8)	9 (39.1)	8 (42.1)	9 (36.0)
Lower	35 (52.2)	12 (52.2)	8 (42.1)	15 (60.0)
Lesion circumferential ratio/n(%)					0.310
<0.50	20 (29.9)	5 (21.7)	8 (42.1)	7 (28.0)
≥0.50 and<0.75	31 (46.3)	13 (56.5)	9 (47.4)	9 (36.0)
≥0.75	12 (17.9)	5 (21.7)	1 (5.3)	6 (24.0)
Unknown^①	4 (6.0)	0 (0)	1 (5.3)	3 (12.0)
Histological grading/n(%)					0.084
G1	14 (20.9)	5 (21.7)	4 (21.1)	5 (20.0)
G2	29 (43.3)	5 (21.7)	9 (47.4)	15 (60.0)
G3	14 (20.9)	9 (39.1)	2 (10.5)	3 (12.0)
Gx	10 (14.9)	4 (17.4)	4 (21.1)	2 (8.0)
Pathology T stage after ESD/n(%)					0.066
pT1b-SM1	28 (41.8)	7 (30.4)	6 (31.6)	15 (60.0)
pT1b-SM2	39 (58.2)	16 (69.6)	13 (68.4)	10 (40.0)
Vertical margin/n(%)					0.075
Positive	18 (26.9)	9 (39.1)	6 (31.6)	3 (12)
Negative	48 (71.6)	13 (56.5)	13 (68.4)	22 (88)
Unknown^①	1 (1.5)	1 (4.3)	0 (0)	0 (0)
Horizontal margin/n(%)					0.814
Positive	21 (31.3)	6 (26.1)	6 (31.6)	9 (36.0)
Negative	45 (67.2)	16 (69.6)	13 (68.4)	16 (64.0)
Unknown^①	1 (1.5)	1 (4.3)	0 (0)	0 (0)
Lymphovascular invasion/n(%)					0.279
Positive	7 (10.4)	4 (17.4)	2 (10.5)	1 (4.0)
Negative	57 (85.1)	17 (73.9)	17 (89.5)	23 (92.0)
Unknown^①	3 (4.5)	2 (8.7)	0 (0)	1 (4.0)

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