Yamamoto Yoshinobu, Ishihara Ryu, Kawakubo Hirofumi, Nishikawa Michiko, Yamamoto Sachiko, Kadota Tomohiro, Abe Seiichiro, Yoshida Masao, Tanaka Tsutomu, Nagano Hiroaki, Nakanishi Hiroyoshi, Yoshizaki Tetsuya, Waki Kotaro, Takahashi Akiko, Kitagawa Yoshiyasu, Mizuno Kenichi, Kawada Kenro, Kono Yoshiyasu, Katada Chikatoshi, Hashimoto Takashi, Nagami Yasuaki, Yoshio Toshiyuki, Shimokawa Toshio, Nihei Keiji, Koyanagi Kazuo, Kato Ken, Yano Tomonori, Muto Manabu, Kitagawa Yuko
Department of Gastrointestinal Oncology, Hyogo Cancer Center, 13-70 Kitaoji-Cho, Akashi, Hyogo, 673-8558, Japan.
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan.
J Gastroenterol. 2025 Jan;60(1):43-54. doi: 10.1007/s00535-024-02188-7. Epub 2024 Dec 3.
Lymphovascular invasion (LVI) or pT1b is noncurative after endoscopic resection (ER) for esophageal squamous cell carcinoma (ESCC), and therefore surgery or chemoradiotherapy (CRT) is recommended. However, there has been debate regarding which treatment has better outcomes and whether individual risks should be considered.
This was a multicenter, retrospective study conducted at 65 hospitals in Japan. The inclusion criteria were patients with ESCC who underwent ER between January 2006 and December 2015, with pT1a-muscularis mucosa (MM) with LVI or pT1b, with negative vertical margins, cN0M0, and who underwent surgery or CRT. A 1:1 propensity score-matched analysis was performed between two groups. The primary and secondary end points were overall survival (OS) and relapse-free survival (RFS). OS and RFS were also compared between two subgroups: low risk (pT1a-MM with LVI and pT1b without LVI) and high risk (pT1b with LVI) for metastatic recurrence.
Among 472 patients, 160 patients were selected from each group. The OS and RFS did not differ between surgery and CRT groups (hazard ratio, 0.887; P = .635 and hazard ratio, 1.036; P = .876, respectively). Subgroup analysis showed that CRT had a better prognosis in the low-risk group, and conversely, surgery had a better prognosis in the high-risk group. But these were not significant. The high-risk CRT group had a significant worse prognosis than the low-risk CRT group.
In patients with noncurative ER for ESCC, surgery and CRT showed no difference in long-term outcomes. Indications for CRT in the high-risk group need further investigation because of poor prognosis.
对于食管鳞状细胞癌（ESCC），内镜切除（ER）后出现淋巴管浸润（LVI）或pT1b属于非根治性情况，因此推荐手术或放化疗（CRT）。然而，关于哪种治疗效果更好以及是否应考虑个体风险一直存在争议。
这是一项在日本65家医院进行的多中心回顾性研究。纳入标准为2006年1月至2015年12月期间接受ER的ESCC患者，病理为pT1a-黏膜肌层（MM）伴LVI或pT1b，切缘阴性，cN0M0，且接受了手术或CRT。对两组进行1:1倾向评分匹配分析。主要和次要终点分别为总生存期（OS）和无复发生存期（RFS）。还比较了两个亚组的OS和RFS：转移复发低风险组（pT1a-MM伴LVI和无LVI的pT1b）和高风险组（有LVI的pT1b）。
472例患者中，每组各选取160例。手术组和CRT组的OS和RFS无差异（风险比分别为0.887；P = 0.635和风险比为1.036；P = 0.876）。亚组分析显示，CRT在低风险组预后较好，相反，手术在高风险组预后较好。但差异均无统计学意义。高风险CRT组的预后明显差于低风险CRT组。
对于ESCC非根治性ER患者，手术和CRT的长期结局无差异。由于预后较差，高风险组CRT的适应证需要进一步研究。
