Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Sci Rep. 2021 Mar 22;11(1):6554. doi: 10.1038/s41598-021-85572-0.
In Japan, preoperatively diagnosed T1a-muscularis mucosae or T1b-submucosa 1 (MM/SM1) esophageal squamous cell carcinoma (ESCC) is a relative indication for endoscopic resection (ER). We evaluated long-term outcomes in patients after ER for non-circumferential ESCC with a preoperative diagnosis of MM/SM1 invasion. We retrospectively reviewed 66 patients with a preoperative diagnosis of non-circumferential MM/SM1 ESCC endoscopically resected between 2010 and 2015. Patients were divided into low- (adequate follow-up) and high-risk (requiring additional treatment) groups for lymph node metastasis according to risk factors (submucosal invasion, lymphovascular invasion, or droplet infiltration) and long-term outcomes were analyzed. Pathological invasion to T1a-lamina propria mucosa, MM/SM1, and T1b-SM2 was seen in 22, 38, and 6 lesions, respectively. Overall, 71.2% patients were classified into the "adequate follow-up" group. Of these, only one patient had a lymph node recurrence, which was successfully treated by additional therapy. The remaining 28.8% patients were classified into the "requiring additional treatment" group, where no recurrences were observed after additional treatments. After a median follow-up of 58.6 months, no deaths happened due to ESCC. The 3- and 5-year overall survival rates were 93.6% and 88.7%, respectively. ER is a valid initial treatment for non-circumferential ESCC with preoperatively diagnosed MM/SM1 invasion.
在日本，术前诊断为 T1a-黏膜肌层或 T1b-黏膜下层 1（MM/SM1）的食管鳞癌（ESCC）是内镜下切除（ER）的相对适应证。我们评估了术前诊断为 MM/SM1 侵犯的非环周 ESCC 患者 ER 后的长期结果。我们回顾性分析了 2010 年至 2015 年间经内镜切除的 66 例术前诊断为非环周 MM/SM1 ESCC 的患者。根据危险因素（黏膜下浸润、淋巴管血管侵犯或微滴浸润）将患者分为低（淋巴结转移风险低，需要充分随访）和高（需要额外治疗）风险组，并分析长期结果。病理侵袭至 T1a-固有层黏膜、MM/SM1 和 T1b-SM2 的患者分别为 22、38 和 6 例。总体而言，71.2%的患者被归入“充分随访”组。其中，仅有 1 例患者出现淋巴结复发，经额外治疗成功治疗。其余 28.8%的患者被归入“需要额外治疗”组，这些患者在接受额外治疗后均未出现复发。在中位随访 58.6 个月后，没有患者因 ESCC 死亡。3 年和 5 年总生存率分别为 93.6%和 88.7%。对于术前诊断为 MM/SM1 侵犯的非环周 ESCC，ER 是一种有效的初始治疗方法。
