Feng Yong, Wei Wei, Guo Shuo, Li Bao-Qing
Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China.
Department of Outpatients, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China.
Exp Ther Med. 2022 May 20;24(1):457. doi: 10.3892/etm.2022.11384. eCollection 2022 Jul.
Endoscopic resection for early esophageal cancer has a risk of residual margins. The risk these residual margins pose have not been fully evaluated. The present study aimed to investigate the associated risk factors and prognosis of residual margins following the endoscopic resection of early esophageal squamous cell carcinoma. In total, 369 patients (381 lesions) with early esophageal squamous cell carcinoma treated in the Fourth Hospital of Hebei Medical University (Shijiazhuang, China) with endoscopic resection were retrospectively analyzed. Sex, age, location, tumor diameter, depth of tumor invasion, endoscopic treatment, endoscopic ultrasonography (EUS) before resection, work experience of endoscopists and the degree of tumor differentiation were all evaluated as potential risk factors. In addition, the prognosis of patients with positive margins were analyzed. A total of 73 patients (73/381, 19.2%) had positive margins after endoscopic resection. Amongst the 65 patients who were successfully followed up, five patients succumbed to cardiovascular and cerebrovascular diseases, one patient received radiotherapy, two patients received radiotherapy and chemotherapy whilst one patient received chemotherapy. By contrast, 12 patients received surgery and 20 patients received additional endoscopic mucosal resection or endoscopic submucosal dissection. The other 29 patients were followed up regularly and no recurrence could be found. Univariate analysis revealed that tumor diameter, endoscopic treatment, depth of invasion, EUS before resection, degree of tumor differentiation and direction of invasion were all associated with the positive margin. Multivariate logistic regression analysis then found that EUS before resection, degree of tumor differentiation and depth of tumor invasion are independent risk factors for positive margins after endoscopic resection. These results suggest that poorly differentiated lesions and deeper invasion depth can increase the risk of positive margin after endoscopic resection. As a result, EUS evaluation before resection may reduce the risk of invasion depth. In addition, for poorly differentiated lesions, more aggressive treatment regimens may be recommended for preventing recurrence.
早期食管癌的内镜切除术存在切缘残留风险。这些切缘残留所带来的风险尚未得到充分评估。本研究旨在探讨早期食管鳞状细胞癌内镜切除术后切缘残留的相关危险因素及预后情况。对在河北医科大学第四医院（中国石家庄）接受内镜切除术治疗的369例早期食管鳞状细胞癌患者（381个病灶）进行回顾性分析。将性别、年龄、位置、肿瘤直径、肿瘤浸润深度、内镜治疗方式、切除术前的内镜超声检查（EUS）、内镜医师的工作经验以及肿瘤分化程度均作为潜在危险因素进行评估。此外，还对切缘阳性患者的预后进行了分析。共有73例患者（73/381，19.2%）在内镜切除术后切缘阳性。在成功随访的65例患者中，5例死于心脑血管疾病，1例接受了放疗，2例接受了放疗和化疗，1例接受了化疗。相比之下，12例患者接受了手术，20例患者接受了额外的内镜黏膜切除术或内镜黏膜下剥离术。另外29例患者进行了定期随访，未发现复发情况。单因素分析显示，肿瘤直径、内镜治疗方式、浸润深度、切除术前的EUS、肿瘤分化程度以及浸润方向均与切缘阳性有关。多因素逻辑回归分析发现，切除术前的EUS、肿瘤分化程度和肿瘤浸润深度是内镜切除术后切缘阳性的独立危险因素。这些结果表明，低分化病变和更深的浸润深度会增加内镜切除术后切缘阳性的风险。因此，切除术前进行EUS评估可能会降低浸润深度的风险。此外，对于低分化病变，可能建议采用更积极的治疗方案以预防复发。
