Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, 350001, Fujian Province, China.
Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.
Surg Endosc. 2023 Oct;37(10):7698-7708. doi: 10.1007/s00464-023-10334-0. Epub 2023 Aug 10.
The effects of minimally invasive total mesoesophageal excision (MITME) on the long-term prognosis of locally advanced esophageal squamous cell carcinoma (ESCC) remain unknown. The objective of this study was to compare the static and dynamic failure patterns of MITME and minimally invasive esophagectomy (MIE) for locally advanced ESCC.
We use propensity score matching (PSM) method to analyze the postoperative failure patterns of the two groups. Cumulative event curves were analyzed for cumulative incidence of failure between different groups, and independent prognostic factors were assessed using time-dependent multivariate analyses. The risk of dynamic failure calculated at 12-month intervals was compared between the two groups using the lifetime table.
A total of 366 ESCC patients were studied by 1:1 PSM for T stage and TNM stage (MITME group, n = 183; MIE group, n = 183). In the matched cohort, there was significant differences between the MITME and MIE groups in the failure pattern of regional lymph node recurrence (0.5 vs 3.8%, P = 0.032) and non-tumor death (10.9 vs 31.7%, P < 0.001). The cumulative event curve found that the 5-year cumulative failure rate was lower in the MITME group than in the MIE group (3.3 vs 17.1%, P = 0.026) after 5 years of survival. In addition, multivariate Cox regression analysis showed that MIE was an independent poor prognostic factor for a high cumulative failure rate in locally advanced ESCC patients at 5 years after surgery (HR:4.110; 95% CI 1.047-16.135; P = 0.043). The dynamic risk curve showed that the MITME group had a lower risk of failure within 5 years after surgery than the MIE group.
Considering that MITME can significantly improve the postoperative failure pattern and the benefit lasts for at least 5 years, it is feasible to use MITME as a treatment for locally advanced ESCC.
微创全食管系膜切除术（MITME）对局部晚期食管鳞癌（ESCC）的长期预后的影响尚不清楚。本研究旨在比较 MITME 和微创食管切除术（MIE）治疗局部晚期 ESCC 的静态和动态失败模式。
我们使用倾向评分匹配（PSM）方法分析两组的术后失败模式。通过累积事件曲线分析不同组之间失败的累积发生率，并使用时间依赖性多变量分析评估独立的预后因素。使用寿命表比较两组之间以 12 个月为间隔计算的动态失败风险。
通过 T 分期和 TNM 分期的 1:1 PSM 对 366 例 ESCC 患者进行了研究（MITME 组，n=183；MIE 组，n=183）。在匹配队列中，MITME 组和 MIE 组在区域淋巴结复发的失败模式方面存在显著差异（0.5% vs. 3.8%，P=0.032）和非肿瘤死亡（10.9% vs. 31.7%，P<0.001）。累积事件曲线发现，在 MITME 组中，5 年累积失败率低于 MIE 组（3.3% vs. 17.1%，P=0.026）。此外，多变量 Cox 回归分析显示，MIE 是局部晚期 ESCC 患者术后 5 年累积失败率高的独立不良预后因素（HR：4.110；95%CI 1.047-16.135；P=0.043）。动态风险曲线显示，MITME 组在手术后 5 年内失败的风险低于 MIE 组。
考虑到 MITME 可以显著改善术后失败模式，并且这种益处至少持续 5 年，因此使用 MITME 治疗局部晚期 ESCC 是可行的。
