经放化疗后局部复发的食管鳞癌行挽救性内镜黏膜下剥离术的长期疗效。

Long-term outcomes of salvage endoscopic submucosal dissection for local failure after chemoradiotherapy for esophageal squamous cell carcinoma.

机构信息

Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.

Department of Gastroenterology & Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

出版信息

Jpn J Clin Oncol. 2021 Jul 1;51(7):1036-1043. doi: 10.1093/jjco/hyab027.

DOI:10.1093/jjco/hyab027

PMID:33758950

Abstract

BACKGROUND

Salvage endoscopic submucosal dissection is considered a minimally invasive treatment for local failure after chemoradiotherapy for esophageal squamous cell carcinoma. However, the long-term outcomes have not been fully evaluated. This study investigated the short-term and long-term outcomes of salvage endoscopic submucosal dissection.

METHODS

Patients who underwent endoscopic submucosal dissection for local recurrence or residual tumor after chemoradiotherapy from January 2006 to December 2017 were retrospectively investigated. Follow-up included endoscopic examination and computed tomography at least once every 6 months after salvage endoscopic submucosal dissection. Risk factors for disease recurrence after salvage endoscopic submucosal dissection were assessed using the Cox hazards model.

RESULTS

A total of 30 patients (33 cases of esophageal squamous cell carcinoma: local recurrence, n = 27; residual tumor, n = 6) were included. The median endoscopic submucosal dissection procedure time was 40 min (interquartile range [IQR], 33-58.5 min). En bloc resection was achieved in 31 (94%) of 33 esophageal squamous cell carcinoma cases. One patient with intraoperative perforation did not require surgical intervention and recovered with conservative treatment. A total of 16 patients (53%) had disease recurrence at a median follow-up of 51 months (IQR, 33-81 months). The 3-year overall, disease-specific, recurrence-free and local recurrence-free survival rates were 75%, 82%, 58% and 90%, respectively. The positive vertical margin, submucosal invasion in the endoscopic submucosal dissection specimen and piecemeal resection were significantly associated with disease recurrence after salvage endoscopic submucosal dissection.

CONCLUSIONS

Salvage endoscopic submucosal dissection is a feasible treatment for local failure after chemoradiotherapy for esophageal squamous cell carcinoma with acceptable long-term outcomes. However, for cases with positive vertical margins and submucosal invasion in the endoscopic submucosal dissection specimen, salvage endoscopic submucosal dissection outcomes were insufficient and additional treatment might be required.

摘要

背景

挽救性内镜黏膜下剥离术被认为是放化疗后食管鳞癌局部复发的一种微创治疗方法。然而，其长期疗效尚未得到充分评估。本研究旨在探讨挽救性内镜黏膜下剥离术的短期和长期疗效。

方法

回顾性分析 2006 年 1 月至 2017 年 12 月期间接受内镜黏膜下剥离术治疗放化疗后局部复发或残留肿瘤的患者。挽救性内镜黏膜下剥离术后的随访包括内镜检查和计算机断层扫描，至少每 6 个月 1 次。采用 Cox 风险模型评估挽救性内镜黏膜下剥离术后疾病复发的危险因素。

结果

共纳入 30 例患者（33 例食管鳞癌：局部复发 27 例，残留肿瘤 6 例）。内镜黏膜下剥离术的中位手术时间为 40 分钟（四分位距 33-58.5 分钟）。33 例食管鳞癌中，整块切除率为 94%（31/33）。1 例术中穿孔患者未行手术干预，经保守治疗后痊愈。中位随访 51 个月（四分位距 33-81 个月）时，共有 16 例（53%）患者出现疾病复发。3 年总体生存率、疾病特异性生存率、无复发生存率和局部无复发生存率分别为 75%、82%、58%和 90%。阳性垂直切缘、内镜黏膜下剥离术标本黏膜下浸润和分片切除与挽救性内镜黏膜下剥离术后疾病复发显著相关。