Long-term clinical outcomes of patients diagnosed with pT1a-muscularis mucosae with lymphovascular invasion or pT1b after endoscopic resection for cT1N0M0 esophageal squamous cell carcinoma

Tomohiro Kadota; Daiki Sato; Atsushi Inaba; Keiichiro Nishihara; Kenji Takashima; Keiichiro Nakajo; Hiroki Yukami; Saori Mishima; Kentaro Sawada; Daisuke Kotani; Hisashi Fujiwara; Masaki Nakamura; Hidehiro Hojo; Yusuke Yoda; Takashi Kojima; Takeo Fujita; Tomonori Yano

doi:10.1007/s10388-021-00873-7

Long-term clinical outcomes of patients diagnosed with pT1a-muscularis mucosae with lymphovascular invasion or pT1b after endoscopic resection for cT1N0M0 esophageal squamous cell carcinoma

Esophagus. 2022 Jan;19(1):153-162. doi: 10.1007/s10388-021-00873-7. Epub 2021 Aug 22.

Authors

Tomohiro Kadota¹, Daiki Sato², Atsushi Inaba², Keiichiro Nishihara², Kenji Takashima², Keiichiro Nakajo², Hiroki Yukami³, Saori Mishima³, Kentaro Sawada³, Daisuke Kotani³, Hisashi Fujiwara⁴, Masaki Nakamura⁵, Hidehiro Hojo⁵, Yusuke Yoda², Takashi Kojima³, Takeo Fujita⁴, Tomonori Yano²

Affiliations

¹ Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan. tkadota@east.ncc.go.jp.
² Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan.
³ Department of Gastroenterology, Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
⁴ Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
⁵ Department of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Japan.

PMID: 34420139
DOI: 10.1007/s10388-021-00873-7

Abstract

Background: Endoscopic resection (ER) is performed for early esophageal squamous cell carcinoma (ESCC) cases. Additional esophagectomy or chemoradiotherapy is recommended for non-curative resection (NCR) even with pathologically negative vertical margins (pVM0); however, their clinical outcomes remain unknown. We examined the long-term clinical outcomes of NCR for ESCCs according to additional treatments.

Methods: We retrospectively analyzed the data of patients who underwent ER for cT1N0M0 ESCC between 2009 and 2017 judged to have NCR, which defined when pathologically diagnosed as invading the submucosa (SM) or muscularis mucosae (MM) involving lymphovascular invasion (LVI), pVM0, and endoscopically judged as negative horizontal margin. Additional esophagectomy (involving three-field lymphadenectomy), chemoradiotherapy [mainly cisplatin and 5-fluorouracil with concurrent radiotherapy (41.4 Gy)], or observation was undertaken. Thereafter, computed tomography was performed every 6-12 months. The cumulative recurrence (CRR) and recurrence-free survival (RFS) rates were evaluated.

Results: Eighty-nine patients were included. Among them, 14 had pathologically diagnosed pMM with LVI; 9 and 6, and 32 and 28 patients had pSM1 and pSM2 without and with LVI. Twenty-one patients underwent observation, whereas 18 and 50 underwent esophagectomy and chemoradiotherapy. During the 60.6-month median follow-up period, nine patients had recurrence; among them, six patients had occurrence at > 4 years after ER. The 5-year CRR/RFS rates were 35.7%/48.1%, 13.4%/80.4%, and 0.0%/98.0% in the observation, esophagectomy, and chemoradiotherapy groups, respectively (observation vs. chemoradiotherapy; P < 0.001).

Conclusions: Additional treatments showed better long-term outcomes than observation for patients with NCR. As recurrence may occur at > 4 years after ER, careful long-term follow-up examinations are needed.

Keywords: Chemoradiotherapy; Endoscopic mucosal resection; Endoscopic submucosal dissection; Esophageal squamous cell carcinoma; Esophagectomy.

MeSH terms

Esophageal Neoplasms* / surgery
Esophageal Squamous Cell Carcinoma* / surgery
Humans
Mucous Membrane / pathology
Retrospective Studies
Treatment Outcome