Gastroenterology Department, Cochin Hospital - APHP, Paris, France.
Faculté Paris Descartes, Paris, France.
United European Gastroenterol J. 2019 Oct;7(8):1084-1092. doi: 10.1177/2050640619852260. Epub 2019 May 22.
Endoscopic submucosal dissection is the reference treatment for early oesophageal squamous cell carcinoma. However, data from Western centres are scarce.
We conducted a retrospective study from a prospectively collected database at a tertiary care centre in France. All consecutive patients undergoing endoscopic submucosal dissection for oesophageal squamous cell carcinoma were included. The main outcome was the curative resection rate. Secondary outcomes were en-bloc resection rates, histologically complete resection rates, morbidity, recurrence-free and overall survival.
Fifty-six cases of oesophageal squamous cell carcinoma (49 patients; mean age 61.5 ± 10 years; 36 men) were included. En-bloc, histologically complete and curative resection rates were 98%, 86% and 71%, respectively. Fifteen (30%) patients received an additional treatment after endoscopic submucosal dissection, nine treated by chemoradiotherapy, four by surgery and two by further endoscopic submucosal dissection. Within a mean follow-up of 21 ± 15 months, recurrences occurred in 14 (29%) patients (four local, eight metachronous and three distant recurrences). Eight patients died during follow-up, of which two (4%) patients died from oesophageal squamous cell carcinoma. Factors significantly associated with mortality in this series were: moderate or poor differentiation of oesophageal squamous cell carcinoma ( = 0.02) and recurrence of oesophageal squamous cell carcinoma ( = 0.028).
Moderately or poorly differentiated cancer is a major prognostic factor and should probably be taken into account when indicating an additional treatment after endoscopic submucosal dissection. Close endoscopic follow-up is essential considering the high recurrence rate.
内镜黏膜下剥离术是治疗早期食管鳞状细胞癌的首选方法。然而，来自西方中心的数据却很少。
我们在法国的一家三级护理中心进行了一项回顾性研究，该研究基于前瞻性收集的数据库。所有连续接受内镜黏膜下剥离术治疗食管鳞状细胞癌的患者均纳入本研究。主要结局是根治性切除率。次要结局包括整块切除率、组织学完全切除率、发病率、无复发生存率和总生存率。
56 例食管鳞状细胞癌（49 例患者；平均年龄 61.5±10 岁；36 例男性）纳入本研究。整块切除、组织学完全切除和根治性切除率分别为 98%、86%和 71%。15 例（30%）患者在接受内镜黏膜下剥离术后接受了额外治疗，其中 9 例接受了放化疗，4 例接受了手术治疗，2 例接受了进一步的内镜黏膜下剥离术。在平均 21±15 个月的随访中，14 例（29%）患者出现复发（4 例局部复发，8 例异时性复发，3 例远处复发）。8 例患者在随访期间死亡，其中 2 例（4%）死于食管鳞状细胞癌。该系列研究中与死亡率显著相关的因素是：食管鳞状细胞癌的中度或低分化（ = 0.02）和食管鳞状细胞癌的复发（ = 0.028）。
中或低分化癌是一个重要的预后因素，在指示内镜黏膜下剥离术后进行额外治疗时应考虑到这一点。考虑到高复发率，密切的内镜随访至关重要。
