Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Miyagi, Japan.
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
Dis Esophagus. 2024 Oct 28;37(11). doi: 10.1093/dote/doae048.
Although esophageal cancers invading the muscularis mucosa (pT1a-MM) or submucosa (pT1b-SM) after endoscopic resection (ER) are associated with a risk of lymph node metastasis, details of metastatic recurrence after additional treatment remain unknown. We aimed to identify the risk factors for metastatic recurrence and recurrence patterns in patients receiving additional treatment after ER for esophageal cancer. Between 2006 and 2017, patients with pT1a-MM/pT1b-SM esophageal cancer who underwent ER with additional treatment (esophagectomy, chemoradiotherapy [CRT], and radiation therapy) at 21 institutions in Japan were enrolled. We evaluated the risk factors for metastatic recurrence after ER with additional treatment. Subsequently, the rate and pattern (locoregional or distant) of metastatic recurrence were investigated for each additional treatment. Of the 220 patients who received additional treatment, 57, 125, and 38 underwent esophagectomy, CRT, and radiation therapy, respectively. In the multivariate analysis, lymphatic invasion was the sole risk factor for metastatic recurrence after additional treatment (hazard ratio, 3.50; P = 0.029). Although the risk of metastatic recurrence with additional esophagectomy was similar to that with CRT (hazard ratio, 1.01; P = 0.986), the rate of locoregional recurrence tended to be higher with additional esophagectomy (80.0% (4/5) vs. 36.4% (4/11)), leading to a better prognosis in patients with metastatic recurrence after additional esophagectomy than CRT (survival rate, 80.0% (4/5) vs. 9.1% (1/11)). Patients with lymphatic invasion have a high risk of metastatic recurrence after ER with additional treatment for pT1a-MM/pT1b-SM esophageal cancer. Additional esophagectomy may result in a better prognosis after metastatic recurrence.
尽管内镜下切除（ER）后侵犯黏膜肌层（pT1a-MM）或黏膜下层（pT1b-SM）的食管腺癌（食管癌）有淋巴结转移的风险，但接受 ER 后追加治疗的患者转移复发的详细情况尚不清楚。本研究旨在明确 ER 后追加治疗的食管癌患者发生转移复发的危险因素和复发模式。2006 年至 2017 年，日本 21 家机构共纳入 220 例接受 ER 联合追加治疗（食管切除术、放化疗、放疗）的 pT1a-MM/pT1b-SM 食管癌患者。评估了 ER 后追加治疗患者发生转移复发的危险因素。随后，分析了每种追加治疗的转移复发率和模式（局部或远处）。在 220 例接受追加治疗的患者中，57 例、125 例和 38 例分别接受了食管切除术、放化疗和放疗。多因素分析显示，淋巴管浸润是 ER 后追加治疗发生转移复发的唯一危险因素（风险比，3.50；P=0.029）。尽管追加食管切除术的转移复发风险与放化疗相似（风险比，1.01；P=0.986），但追加食管切除术的局部复发率更高（80.0%（4/5）vs.36.4%（4/11）），因此在发生转移复发的患者中，追加食管切除术的预后优于放化疗（生存率，80.0%（4/5）vs.9.1%（1/11））。pT1a-MM/pT1b-SM 食管癌患者 ER 后追加治疗有发生转移复发的高风险。发生转移复发后追加食管切除术可能会改善预后。
