胸腹腔镜联合McKeown食管癌切除术与内镜黏膜下剥离术治疗早期食管鳞状细胞癌的生存结果：一项倾向评分匹配分析
Survival Outcome of Thoraco-Laparoscopic McKeown Esophagectomy Versus Endoscopic Submucosal Dissection for Early-Stage Esophageal Squamous Cell Carcinoma: A Propensity Score-Matched Analysis.
作者信息
Yuan Ping, Huang Zhenhao, Bao Feichao, Li Jiajing, Chen Lidong, Wen Hongtao, Liu Donglei, Li Feng, Zhang Shanfeng, Qi Yu, Li Xiangnan
机构信息
Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
出版信息
Thorac Cancer. 2025 May;16(9):e70064. doi: 10.1111/1759-7714.70064.
OBJECTIVE
To evaluate thoraco-laparoscopic McKeown esophagectomy (TLME) versus endoscopic submucosal dissection (ESD) for clinical-T1N0 esophageal squamous cell carcinoma (ESCC) depending on invasion depth.
BACKGROUND
Early-stage ESCC has been widely treated by endoscopic resection. While ESD is safer than esophagectomy perioperatively, its survival benefits for clinical-T1N0M0 ESCC, especially high-risk T1b tumors, are unclear.
METHODS
A retrospective study was conducted on clinical-T1N0 ESCC patients at the First Affiliated Hospital of Zhengzhou University comparing TLME (cT1a, n = 352; cT1b, n = 205) with ESD (cT1a, n = 499; cT1b, n = 62). Overall survival (OS), disease-specific survival (DSS), relapse-free survival (RFS), and metastasis-free survival (MFS) were analyzed depending on invasion depth after propensity score matching to account for selection bias.
RESULTS
ESD group had better OS (hazard ratio: 0.54, p = 0.029) but worse RFS (hazard ratio: 6.83, p < 0.001) than TLME group in general terms. T1a cancers showed no difference in DSS and MFS between groups. T1b subgroup with ESD had lower DSS (hazard ratio: 5.65, p = 0.036) and MFS (hazard ratio: 3.54, p = 0.069). R1-resection in ESD group linked to poorer OS (hazard ratio: 5.89, p = 0.006) and DSS (hazard ratio: 3.67, p = 0.006).
CONCLUSION
ESD can be safe in the treatment of clinical-T1aN0 ESCC. However, concerning oncologic curability, TLME should be recommended for patients with clinical-T1bN0 ESCC in terms of favorable DSS, RFS, and MFS.
目的
根据浸润深度，评估胸腔镜辅助腹腔镜McKeown食管癌切除术（TLME）与内镜黏膜下剥离术（ESD）治疗临床T1N0期食管鳞状细胞癌（ESCC）的效果。
背景
早期ESCC已广泛采用内镜下切除术治疗。虽然ESD在围手术期比食管癌切除术更安全，但其对临床T1N0M0期ESCC，尤其是高危T1b肿瘤的生存获益尚不清楚。
方法
对郑州大学第一附属医院的临床T1N0期ESCC患者进行回顾性研究，比较TLME组（cT1a，n = 352；cT1b，n = 205）与ESD组（cT1a，n = 499；cT1b，n = 62）。在进行倾向得分匹配以消除选择偏倚后，根据浸润深度分析总生存期（OS）、疾病特异性生存期（DSS）、无复发生存期（RFS）和无转移生存期（MFS）。
结果
总体而言，ESD组的OS较好（风险比：0.54，p = 0.029），但RFS较差（风险比：6.83，p < 0.001）。T1a期癌症在两组间的DSS和MFS无差异。ESD组的T1b亚组DSS较低（风险比：5.65，p = 0.036），MFS较低（风险比：3.54，p = 0.069）。ESD组的R1切除与较差的OS（风险比：5.89，p = 0.006）和DSS（风险比：3.67，p = 0.006）相关。
结论
ESD治疗临床T1aN0期ESCC可能是安全的。然而，在肿瘤学可治愈性方面，就良好的DSS、RFS和MFS而言，对于临床T1bN0期ESCC患者，应推荐TLME。
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