Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.
Esophagus. 2021 Jul;18(3):585-593. doi: 10.1007/s10388-021-00814-4. Epub 2021 Jan 21.
Previous guidelines have not described clear recommendations for performing endoscopic resection (ER) of T1a-muscularis mucosa (MM)/T1b-submucosal (SM1) cancers that have invaded ≤ 200 μm because these are considered to have a non-negligible risk of metastasis based on previous analyses of pathologically diagnosed (p)MM/SM1 cancers. Considering that the indication for ER is determined based on a clinical diagnosis, the applicability of ER should be investigated in clinical (c)MM/SM1 but not pMM/SM1 cancers. This study aimed to evaluate validity of ER for cMM/SM1 cancers.
In total, 175 cMM/SM1 esophageal squamous cell carcinoma cases that were endoscopically or surgically resected between January 2008 and December 2018 were identified from a prospectively maintained database. We histologically evaluated resected specimens and divided them into low- (n = 92) and high-risk (n = 83) cancers for metastasis.
Univariate analysis showed that longer tumor length and larger circumferential extent were significantly correlated with high-risk cancer (P < 0.001). Multivariate analysis showed that tumor circumference was an independent predictor of high-risk cancer (P = 0.036). The proportion of low-risk cancers among cases with ≤ 3/4, > 3/4 and < 1, and whole circumferential extent were 59, 17, and 14%, respectively, and the post-ER stricture rates of these groups were 12, 33, and 100%, respectively.
ER is the first-line treatment for cMM/SM1 cancers with ≤ 3/4 circumferential extent considering that 59% of cMM/SM1 cancers were low-risk cancers for which ER is mostly curative. ER is not recommended for whole circumferential cMM/SM1 cancers given the low proportion of low-risk cancers and the high risk of stricture after ER.
之前的指南并未对 T1a-黏膜肌层（MM）/T1b-黏膜下层（SM1）侵袭深度≤200μm 的癌症行内镜下切除术（ER）提出明确建议，因为之前对病理诊断的 MM/SM1 癌症的分析显示这些癌症具有不可忽视的转移风险。由于 ER 的适应证是基于临床诊断确定的，因此应该在临床 MM/SM1 癌症（cMM/SM1）中而不是在病理诊断的 MM/SM1 癌症（pMM/SM1）中研究 ER 的适用性。本研究旨在评估 ER 治疗 cMM/SM1 癌症的有效性。
本研究从 2008 年 1 月至 2018 年 12 月期间前瞻性维护的数据库中确定了 175 例经内镜或手术切除的 cMM/SM1 食管鳞状细胞癌病例。我们对切除标本进行组织学评估，并将其分为低危（n=92）和高危（n=83）转移癌症。
单因素分析显示，肿瘤长度较长和周径较大与高危癌症显著相关（P<0.001）。多因素分析显示，肿瘤周径是高危癌症的独立预测因子（P=0.036）。周径≤3/4、>3/4 和<1 以及整个周径的低危癌症比例分别为 59%、17%和 14%，这些组的 ER 后狭窄率分别为 12%、33%和 100%。
考虑到 59%的 cMM/SM1 癌症为低危癌症，ER 治疗效果大多较好，因此对于周径≤3/4 的 cMM/SM1 癌症，ER 是一线治疗方法。由于低危癌症比例较低，ER 后狭窄风险较高，因此不建议对整个周径的 cMM/SM1 癌症进行 ER。
