Iwai Naoto, Dohi Osamu, Yamada Shinya, Harusato Akihito, Horie Ryusuke, Yasuda Takeshi, Yamada Nobuhisa, Horii Yusuke, Majima Atsushi, Zen Keika, Kimura Hiroyuki, Yagi Nobuaki, Naito Yuji, Itoh Yoshito
Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan.
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan.
Surg Endosc. 2022 Apr;36(4):2279-2289. doi: 10.1007/s00464-021-08502-1. Epub 2021 Apr 15.
Long-term outcomes of endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma (ESCC) have not been assessed in a large, multicenter cohort. We aimed to evaluate long-term outcomes of ESD for ESCC in a real-world setting.
We retrospectively recruited 659 patients who underwent ESD for ESCC at ten institutions from January 2007 to December 2015. Of these, 566 patients were analyzed and classified into three groups according to the pathologic invasion depth after ESD: epithelium/lamina propria mucosa (EP/LPM group: 454 patients), muscularis mucosa/submucosa invasion ≤ 200 μm below the inferior margin of the muscularis mucosa (MM/SM1 group: 81 patients), and submucosa invasion > 200 μm below the MM inferior margin (SM2 group: 31 patients).
The 5-year overall survival rates in the EP/LPM, MM/SM1, and SM2 groups were 92.6%, 80.0%, and 62.7%, respectively, while the 5-year disease-specific survival rates were 99.7%, 96.9%, and 88.3%, respectively. Multivariate analyses revealed that the invasion depth, Charlson Comorbidity Index (CCI), and prognostic nutritional index (PNI) were independent prognostic factors. Hazard ratios in the MM/SM1 and SM2 groups were 2.25 (95% confidence interval [CI] 1.04-4.83; P = 0.038) and 3.18 (95% CI 1.08-9.34; P = 0.036), respectively, compared to those in the EP/LPM group, while those for patients with a CCI ≥ 3 and PNI ≤ 47.75 were 3.25 (95% CI 1.79-5.89; P < 0.001) and 2.42 (95% CI 1.26-4.65; P = 0.008), respectively.
This study identified that invasion depth, presence of comorbid diseases and preoperative nutritional status are independent prognostic risk factors associated with ESCC patients undergoing ESD.
尚未在大型多中心队列中评估内镜下黏膜下剥离术（ESD）治疗食管鳞状细胞癌（ESCC）的长期疗效。我们旨在评估在现实环境中ESD治疗ESCC的长期疗效。
我们回顾性招募了2007年1月至2015年12月期间在十家机构接受ESD治疗ESCC的659例患者。其中，对566例患者进行了分析，并根据ESD后的病理浸润深度分为三组：上皮/固有层黏膜（EP/LPM组：454例患者）、黏膜肌层/黏膜下层浸润≤黏膜肌层下缘以下200μm（MM/SM1组：81例患者）和黏膜下层浸润>黏膜肌层下缘以下200μm（SM2组：31例患者）。
EP/LPM组、MM/SM1组和SM2组的5年总生存率分别为92.6%、80.0%和62.7%，而5年疾病特异性生存率分别为99.7%、96.9%和88.3%。多因素分析显示，浸润深度、Charlson合并症指数（CCI）和预后营养指数（PNI）是独立的预后因素。与EP/LPM组相比，MM/SM1组和SM²组的风险比分别为2.25（95%置信区间[CI]1.04 - 4.83；P = 0.038）和3.18（95%CI 1.08 - 9.34；P = 0.036），而CCI≥3且PNI≤47.75的患者的风险比分别为3.25（95%CI 1.79 - 5.89；P < 0.001）和2.42（95%CI 1.26 - 4.65；P = 0.008）。
本研究确定浸润深度、合并症的存在和术前营养状况是与接受ESD的ESCC患者相关的独立预后危险因素。
