Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA.
Gastrointest Endosc. 2022 Sep;96(3):445-453. doi: 10.1016/j.gie.2022.02.018. Epub 2022 Feb 22.
The outcomes of endoscopic submucosal dissection (ESD) for T1b esophageal cancer (EC) and its recurrence rates remain unclear in the West. Using a multicenter cohort, we evaluated technical outcomes and recurrence rates of ESD in the treatment of pathologically staged T1b EC.
We included patients who underwent ESD of T1b EC at 7 academic tertiary referral centers in the United States (n = 6) and Brazil (n = 1). We analyzed demographic, procedural, and histopathologic characteristics and follow-up data. Time-to-event analysis was performed to evaluate recurrence rates.
Sixty-six patients with pathologically staged T1b EC after ESD were included in the study. A preprocedure staging EUS was available in 54 patients and was Tis/T1a in 27 patients (50%) and T1b in 27 patients (50%). En-bloc resection rate was 92.4% (61/66) and R0 resection rate was 54.5% (36/66). Forty-nine of 66 patients (74.2%) did not undergo surgery immediately after resection and went on to surveillance. Ten patients had ESD resection within the curative criteria, and no recurrences were seen in a 13-month (range, 3-18.5) follow-up period in these patients. Ten of 39 patients (25.6%) with noncurative resections had residual/recurrent disease. Of the 10 patients with noncurative resection, local recurrence alone was seen in 5 patients (12.8%) and metastatic recurrence in 5 patients (12.8%). On univariate analysis, R1 resection had a higher risk of recurrent disease (hazard ratio, 6.25; 95% confidence interval, 1.29-30.36; P = .023).
EUS staging of T1b EC has poor accuracy, and a staging ESD should be considered in these patients. ESD R0 resection rates were low in T1b EC, and R1 resection was associated with recurrent disease. Patients with noncurative ESD resection of T1b EC who cannot undergo surgery should be surveyed closely, because recurrent disease was seen in 25% of these patients.
在西方，内镜黏膜下剥离术（ESD）治疗 T1b 期食管癌（EC）的疗效及复发率尚不清楚。本研究通过多中心队列研究，评估了 ESD 治疗 T1b 期 EC 的技术疗效和复发率。
纳入美国（n=6）和巴西（n=1）的 7 家学术性三级转诊中心接受 T1b 期 EC ESD 的患者。分析了患者的人口统计学、手术过程和组织病理学特征以及随访数据。采用生存分析评估复发率。
共纳入 66 例经病理分期的 T1b 期 EC 患者。54 例患者在术前进行了超声内镜检查，27 例（50%）为Tis/T1a，27 例（50%）为 T1b。整块切除率为 92.4%（61/66），R0 切除率为 54.5%（36/66）。66 例患者中有 49 例（74.2%）在切除后未立即行手术治疗，而是进行了监测。10 例患者 ESD 切除符合治愈标准，这些患者在 13 个月（3-18.5 个月）的随访期间未见复发。39 例非治愈性切除患者中，10 例（25.6%）患者存在残留/复发疾病。10 例非治愈性切除患者中，5 例（12.8%）为局部复发，5 例（12.8%）为远处转移复发。单因素分析显示，R1 切除的疾病复发风险更高（风险比 6.25；95%置信区间 1.29-30.36；P=0.023）。
T1b 期 EC 的超声内镜分期准确性较差，这些患者应考虑进行分期 ESD。T1b 期 EC 的 ESD 整块 R0 切除率较低，R1 切除与疾病复发相关。不能行手术治疗的 T1b 期 EC 非治愈性 ESD 切除患者应密切监测，因为这些患者中有 25%复发。
