Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Am J Gastroenterol. 2013 Apr;108(4):544-51. doi: 10.1038/ajg.2013.8. Epub 2013 Feb 12.
Long-term outcomes after endoscopic resection (ER) provide important information for the treatment of esophageal carcinoma. This study aimed to investigate the rates of survival and metastasis after ER of esophageal carcinoma.
From 1995 to 2010, 570 patients with esophageal carcinoma were treated by ER. Of these, the 402 patients with squamous cell carcinoma (280 epithelial (EP) or lamina propria (LPM) cancer, 70 muscularis mucosa (MM) cancer, and 52 submucosal (SM) cancer) were included in our analysis. Seventeen patients had cancer invading into the submucosa up to 0.2 mm (SM1) and 35 patients had cancer invading into the submucosa more than 0.2 mm (SM2).
The mean (range) follow-up time was 50 (4-187) months. The 5-year overall survival rates of patients with EP/LPM, MM, and SM cancer were 90.5, 71.1, and 70.8%, respectively (P=0.007). Multivariate analysis identified depth of invasion and age as independent predictors of survival, with hazard ratios of 3.6 for MM cancer and 3.2 for SM cancer compared with EP/LPM cancer, and 1.07 per year of age. The cumulative 5-year metastasis rates in patients with EP/LPM, MM, SM1, and SM2 cancer were 0.4, 8.7, 7.7, and 36.2%, respectively (P<0.001). Multivariate analysis identified depth of invasion as an independent risk factor for metastasis, with hazard ratios of 13.1 for MM, 40.2 for SM1, and 196.3 for SM2 cancer compared with EP/LPM cancer. The cumulative 5-year metastasis rates in patients with mucosal cancer with and without lymphovascular involvement were 46.7 and 0.7%, respectively (P<0.0001).
The long-term risk of metastasis after ER was mainly associated with the depth of invasion. This risk should be taken into account when considering the indications for ER.
内镜下切除（ER）后的长期预后为食管癌的治疗提供了重要信息。本研究旨在探讨 ER 治疗食管癌后的生存率和转移率。
1995 年至 2010 年间，570 例食管癌患者接受 ER 治疗。其中，402 例鳞状细胞癌患者（280 例上皮（EP）或固有层（LPM）癌，70 例黏膜肌层（MM）癌和 52 例黏膜下层（SM）癌）纳入本研究分析。17 例患者为黏膜下侵犯至 0.2mm（SM1），35 例患者为黏膜下侵犯>0.2mm（SM2）。
中位（范围）随访时间为 50（4-187）个月。EP/LPM、MM 和 SM 癌患者的 5 年总生存率分别为 90.5%、71.1%和 70.8%（P=0.007）。多因素分析确定浸润深度和年龄是生存的独立预测因素，MM 癌和 SM 癌的危险比分别为 EP/LPM 癌的 3.6 倍和 3.2 倍，每年增加 1.07 岁。EP/LPM、MM、SM1 和 SM2 癌患者的 5 年累积转移率分别为 0.4%、8.7%、7.7%和 36.2%（P<0.001）。多因素分析确定浸润深度是转移的独立危险因素，MM 癌、SM1 癌和 SM2 癌的危险比分别为 EP/LPM 癌的 13.1 倍、40.2 倍和 196.3 倍。有或无血管侵犯的黏膜癌患者的 5 年累积转移率分别为 46.7%和 0.7%（P<0.0001）。
ER 后长期转移风险主要与浸润深度有关。在考虑 ER 的适应证时，应考虑这一风险。
