Okamura Akihiko, Yoshimizu Shoichi, Kanamori Jun, Imamura Yu, Asari Takao, Nakayama Izuma, Ogura Mariko, Ishiyama Akiyoshi, Yoshio Toshiyuki, Chin Keisho, Fujisaki Junko, Watanabe Masayuki
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, JPN.
Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, JPN.
Cureus. 2022 Mar 10;14(3):e23028. doi: 10.7759/cureus.23028. eCollection 2022 Mar.
Intramural metastasis (IM) in esophageal squamous cell carcinoma (ESCC) is sometimes found, and the prognosis of ESCC patients with pathologically diagnosed IM is known to be dismal. However, there are few reports on ESCC patients with clinically diagnosed IM.
This study assessed 2,772 ESCC patients who underwent endoscopy for initial evaluation. Among them, 85 patients (3.1%) were diagnosed with endoscopic IM. In this study, we investigated these patients' characteristics, survival among the groups stratified by the treatment modalities, and survival predictors.
Of 85 patients, 76 (89.4%) had T3 or T4 tumors, 73 (85.9%) had nodal metastases, and 36 (42.4%) had M1 diseases. Curative-intent treatment could be given to 63 patients (74.1%) with a median survival time (MST) of 15.6 months (95% CI: 10.7-20.4). As initial treatment, upfront surgery (US), neoadjuvant chemotherapy (NAC) using cisplatin and 5-fluorouracil (CF), neoadjuvant chemoradiotherapy, and definitive chemoradiotherapy (dCRT) were given to 17 (27.0%), 27 (42.9%), 2 (3.2%), and 17 patients (27.0%), respectively. dCRT was preferred for T4 tumors compared with US or NAC (P = 0.02). The MST of US and NAC patients was 19.3 (95% CI: 12.9-25.6) and 23.4 months (95% CI: 9.4-37.4), respectively. No significant difference was noted between US and NAC patients (P= 0.89).
The prognosis of ESCC patients with endoscopic IM is poor even if curative-intent treatment is done. Moreover, no significant survival benefit of NAC with CF for these patients was observed when compared with US.
食管鳞状细胞癌（ESCC）中有时会发现壁内转移（IM），已知病理诊断为IM的ESCC患者预后不佳。然而，关于临床诊断为IM的ESCC患者的报道很少。
本研究评估了2772例接受内镜检查进行初始评估的ESCC患者。其中，85例（3.1%）被诊断为内镜下IM。在本研究中，我们调查了这些患者的特征、按治疗方式分层的各组患者的生存率以及生存预测因素。
85例患者中，76例（89.4%）为T3或T4期肿瘤，73例（85.9%）有淋巴结转移，36例（42.4%）有M1期疾病。63例患者（74.1%）可接受根治性治疗，中位生存时间（MST）为15.6个月（95%CI：10.7 - 20.4）。作为初始治疗，17例（27.0%）患者接受了 upfront手术（US），27例（42.9%）患者接受了使用顺铂和5 - 氟尿嘧啶（CF）的新辅助化疗（NAC），2例（3.2%）患者接受了新辅助放化疗，17例（27.0%）患者接受了根治性放化疗（dCRT）。与US或NAC相比，T4期肿瘤患者更倾向于接受dCRT（P = 0.02）。US组和NAC组患者的MST分别为19.3个月（95%CI：12.9 - 25.6）和23.4个月（95%CI：9.4 - 37.4）。US组和NAC组患者之间未观察到显著差异（P = 0.89）。
即使进行了根治性治疗，内镜下IM的ESCC患者预后仍较差。此外，与US相比，这些患者接受CF方案的NAC未观察到显著的生存获益。
