内镜黏膜下剥离术治疗特殊类型食管癌的长期疗效。

Long-Term Outcomes of Endoscopic Submucosal Dissection for Special Type of Esophageal Cancer.

机构信息

Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.

Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.

出版信息

Dig Dis. 2023;41(4):533-542. doi: 10.1159/000529590. Epub 2023 Feb 9.

DOI:10.1159/000529590

PMID:36758528

Abstract

BACKGROUND

Esophageal cancers other than two types, squamous cell carcinoma (SCC) and adenocarcinoma, are commonly referred to as special type of esophageal cancer (STEC). Studies on STECs have been limited because of its low prevalence. Therefore, we aimed to clarify the clinicopathological findings and the long-term outcomes of STECs that were managed with ESD.

METHODS

We reviewed 713 patients with 1,089 lesions who underwent ESD for primary esophageal cancer except Barrett's esophageal cancer. Patients were classified into the SCC group and the STEC group, respectively. Their clinicopathological findings and long-term outcomes including disease-specific survival (DSS) were collected and examined.

RESULTS

A total of 19 consecutive patients (1.7%) were diagnosed with STEC. Nine patients were diagnosed with basaloid carcinoma, 6 with adenosquamous carcinoma, 2 with mucoepidermoid carcinoma, 2 with salivary duct-type carcinoma, and 1 with neuroendocrine cell carcinoma. There was significantly more pT1b esophageal cancer (47.4% vs. 11.0%, p < 0.01) and lymphovascular invasion (31.6% vs. 10.2%, p = 0.011) in the STEC group. Metastatic relapse and disease-specific mortality were significantly higher in the STEC group (both 15.8% vs. 1.2%, p < 0.01), and the STEC group had shorter DSS with 5-year DSS rates of 90.9%. In a subgroup analysis of patients with pT1a esophageal cancer, the 5-year DSS rate was shorter in the STEC group (p < 0.01). In the multivariate analysis, STEC (HR = 0.24) and tumor depth (HR = 12.60) were the factors associated with DSS.

CONCLUSION

STECs are suggested to have high malignant potential and to be an independent negative prognostic factor for DSS.

摘要

背景

除了鳞癌（SCC）和腺癌以外的食管恶性肿瘤通常被称为特殊型食管恶性肿瘤（STEC）。由于其发病率低，对 STEC 的研究有限。因此，我们旨在阐明接受内镜黏膜下剥离术（ESD）治疗的 STEC 的临床病理特征和长期结局。

方法

我们回顾了 713 例接受 ESD 治疗的原发性食管癌（不包括 Barrett 食管）患者的资料，共 1089 处病变。患者分为 SCC 组和 STEC 组，分别收集并检查其临床病理特征和包括疾病特异性生存（DSS）在内的长期结局。

结果

共确诊 19 例连续患者（1.7%）为 STEC。9 例诊断为基底细胞样癌，6 例诊断为腺鳞癌，2 例诊断为黏液表皮样癌，2 例诊断为唾液腺型癌，1 例诊断为神经内分泌细胞癌。STEC 组中 pT1b 食管癌（47.4% vs. 11.0%，p < 0.01）和脉管侵犯（31.6% vs. 10.2%，p = 0.011）更为常见。STEC 组的转移复发和疾病特异性死亡率明显更高（均为 15.8% vs. 1.2%，p < 0.01），且 STEC 组的 DSS 较短，5 年 DSS 率为 90.9%。在 pT1a 食管癌患者的亚组分析中，STEC 组的 5 年 DSS 率更短（p < 0.01）。多因素分析显示，STEC（HR = 0.24）和肿瘤深度（HR = 12.60）是与 DSS 相关的因素。