Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Division of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan.
Endoscopy. 2018 Jul;50(7):662-670. doi: 10.1055/s-0043-124433. Epub 2017 Dec 22.
Esophageal squamous cell carcinoma (ESCC) invading the muscularis mucosae (MM) and submucosa up to 200 µm (SM1) has a risk of metastasis. The aims of this study were to investigate the long-term outcome of endoscopic submucosal dissection (ESD) for MM/SM1 ESCC and to assess the management after ESD in our hospital.
This was a retrospective cohort study conducted at a single institution. Patients with MM or SM1 ESCC who were treated with ESD were included. Additional prophylactic therapy was added if lymphovascular involvement (LVI) was noted in the ESD specimens.
A total of 102 patients were analyzed. The median length of follow-up was 71.5 months (range 9 - 144 months) and the median number of CTs was 6 (range 0 - 24). LVI was found in 21 patients (20.6 %), and 12 patients underwent additional prophylactic therapy. The 5-year overall survival, disease-specific survival, and tumor-free survival rates were 84.1 %, 97.5 %, and 82.1 %, respectively. A total of 26 patients died, but only 2 of them died from ESCC. The cumulative metastasis rate was 11.8 %, and LVI was a significant predictor of metastasis (hazard ratio 5.42, 95 % confidence interval 1.39 - 21.18; = 0.02). There were no differences between patients with MM ESCC and those with SM1 ESCC.
The long-term outcome after ESD for MM/SM1 ESCC was favorable with additional prophylactic therapy and strict adherence to follow-up. These results indicate that our management decision based on LVI is a valid approach and that ESD can be offered as a therapeutic option to MM/SM1 ESCCs.
侵犯黏膜肌层（MM）和黏膜下层达 200μm（SM1）的食管鳞状细胞癌（ESCC）有转移的风险。本研究的目的是探讨内镜黏膜下剥离术（ESD）治疗 MM/SM1 ESCC 的长期疗效，并评估我院 ESD 后的治疗管理。
这是一项单中心回顾性队列研究。纳入接受 ESD 治疗的 MM 或 SM1 ESCC 患者。如果 ESD 标本中发现血管淋巴管侵犯（LVI），则加用预防性治疗。
共分析了 102 例患者。中位随访时间为 71.5 个月（范围 9-144 个月），中位 CT 次数为 6 次（范围 0-24 次）。21 例（20.6%）患者发现 LVI，12 例患者接受了额外的预防性治疗。5 年总生存率、疾病特异性生存率和无瘤生存率分别为 84.1%、97.5%和 82.1%。共有 26 例患者死亡，但只有 2 例死于 ESCC。累积转移率为 11.8%，LVI 是转移的显著预测因子（风险比 5.42，95%置信区间 1.39-21.18；P=0.02）。MM ESCC 患者与 SM1 ESCC 患者之间无差异。
对于 MM/SM1 ESCC，ESD 后加用预防性治疗并严格随访，长期疗效良好。这些结果表明，我们基于 LVI 的治疗决策是有效的，ESD 可以作为 MM/SM1 ESCC 的治疗选择。
