Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan,
Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
Digestion. 2021;102(4):622-629. doi: 10.1159/000510368. Epub 2020 Sep 29.
Multiple Lugol-voiding lesions (LVLs) in the esophagus increase the risk of synchronous and metachronous development of esophageal squamous cell carcinoma (ESCC). Chemoradiotherapy (CRT) following endoscopic submucosal dissection (ESD) may reduce the incidence of metachronous ESCC, but few studies have investigated this. Therefore, we retrospectively examined the effect of CRT on metachronous ESCC and multiple esophageal dysplasias visible as multiple LVLs.
This study reviewed 146 patients who underwent esophageal ESD and were determined pathologically to have noncurative resection. They were divided into 2 groups: those who received additional CRT (CRT group; n = 64) and those without additional treatment (control group; n = 82). Incidence of metachronous ESCC was analyzed using propensity scores to adjust for patient characteristics. The number of multiple LVLs was also examined.
The CRT group was significantly younger than the control group (mean 66.6 vs. 70.6 years, p = 0.011), had significantly deeper tumor invasion (p = 0.013), and had a significantly higher rate of lymphovascular invasion (47.8 vs. 12.2%, p < 0.001). The CRT group also had a significantly higher improvement rate of multiple LVLs (58.1 vs. 2.0%, p < 0.001). The LVLs after CRT had a distinctive irregular crack-shaped appearance. Metachronous ESCC was found in 7 patients (10.9%) in the CRT group and in 17 patients (20.7%) in the control group (p = 0.113). In propensity score-adjusted logistic regression analysis, the odds ratio for metachronous ESCC in the CRT group was 0.316 (p = 0.023). The occurrence rate was significantly lower in the CRT group than in the control group.
DISCUSSION/CONCLUSION: CRT may be effective in preventing metachronous ESCC.
食管多发 Lugol 充盈缺损（LVLs）增加了食管鳞癌（ESCC）同步和异时性发展的风险。内镜黏膜下剥离术（ESD）后行放化疗（CRT）可能降低异时性 ESCC 的发生率，但很少有研究对此进行探讨。因此，我们回顾性研究了 CRT 对多发 LVLs 可见的异时性 ESCC 和多发食管异型增生的治疗效果。
本研究回顾性分析了 146 例接受食管 ESD 治疗且病理检查提示为非治愈性切除的患者。根据是否行额外 CRT 将其分为 CRT 组（n = 64）和对照组（n = 82）。采用倾向性评分调整患者特征后，分析两组异时性 ESCC 的发生率。同时分析多发 LVLs 的数量。
与对照组相比，CRT 组患者年龄显著更小（平均 66.6 岁比 70.6 岁，p = 0.011），肿瘤侵袭深度更深（p = 0.013），脉管侵犯率更高（47.8%比 12.2%，p < 0.001）。CRT 组多发 LVLs 的改善率也显著更高（58.1%比 2.0%，p < 0.001）。CRT 后的 LVLs 呈现出独特的不规则裂纹状外观。CRT 组有 7 例（10.9%）和对照组有 17 例（20.7%）患者发生异时性 ESCC（p = 0.113）。在倾向性评分调整的 logistic 回归分析中，CRT 组异时性 ESCC 的比值比为 0.316（p = 0.023）。CRT 组的发生率显著低于对照组。
讨论/结论：CRT 可能有助于预防异时性 ESCC。
