Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan.
Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan.
Dig Dis Sci. 2023 Sep;68(9):3679-3687. doi: 10.1007/s10620-023-08034-9. Epub 2023 Jul 20.
The therapeutic approach after endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma (ESCC) diagnosed as pathological T1a-muscularis mucosa (pT1a-MM) without lymphovascular involvement (LVI) remains uncertain. We aimed to determine whether observation after ESD is acceptable for patients without LVI showing pT1a-MM cancer.
We retrospectively registered 566 ESCC patients who were treated with ESD at ten institutions between January 2007 and December 2015. Of those, 447 cases showing pT1a-epithelium/lamina propria mucosa (EP/LPM) without LVI and vertical margin (VM) (EP/LPM group), and 41 cases showing pT1a-MM without LVI and VM (MM group) were analyzed in this investigation. The clinical outcomes were assessed between the groups.
The 5 year cumulative incidence of metastatic recurrence was 0.5% and 3.3% in the EP/LPM and MM groups, respectively (P = 0.121). Two cases showing pT1a-EP/LPM and one showing pT1a-MM experienced lymph node recurrence. The 5 year cumulative incidence of local recurrence was 1.5% and 3.8% in the EP/LPM and MM groups, respectively (P = 0.455). The 5 year disease-specific survival (DSS) rate was 99.3% and 96.6% in the EP/LPM and MM groups, respectively (P = 0.118), whereas the 5 year overall survival rate was significantly higher in the EP/LPM group than in the MM group (92.6% versus 81.1%, respectively; P = 0.021).
As regards metastatic recurrence and DSS, ESCC patients with pT1a-MM without LVI showed favorable outcomes that were equivalent to those with pT1a-EP/LPM, even when they were not treated with additional therapy after ESD.
对于诊断为无淋巴血管侵犯（LVI）的内镜黏膜下剥离术（ESD）后食管鳞状细胞癌（ESCC）患者，如果病理为 T1a-黏膜肌层（pT1a-MM），治疗方法仍不确定。我们旨在确定对于无 LVI 且表现为 pT1a-MM 癌症的患者，ESD 后观察是否可以接受。
我们回顾性登记了 2007 年 1 月至 2015 年 12 月在十个机构接受 ESD 治疗的 566 例 ESCC 患者。其中，447 例显示无 LVI 和垂直边缘（VM）的 pT1a-上皮/固有层黏膜（EP/LPM）（EP/LPM 组），41 例显示无 LVI 和 VM 的 pT1a-MM（MM 组）。分析了两组之间的临床结果。
EP/LPM 组和 MM 组的 5 年累积转移复发率分别为 0.5%和 3.3%（P=0.121）。2 例显示 pT1a-EP/LPM，1 例显示 pT1a-MM 出现淋巴结复发。EP/LPM 组和 MM 组的 5 年局部复发累积发生率分别为 1.5%和 3.8%（P=0.455）。EP/LPM 组和 MM 组的 5 年疾病特异性生存率（DSS）分别为 99.3%和 96.6%（P=0.118），而 EP/LPM 组的 5 年总生存率明显高于 MM 组（92.6%比 81.1%，分别；P=0.021）。
就转移复发和 DSS 而言，无 LVI 的 pT1a-MM ESCC 患者的预后与 pT1a-EP/LPM 患者相当，即使他们在 ESD 后未接受额外治疗。
