Risk factors associated with poor prognosis after endoscopic treatment of clinical T1a esophageal cancer.

BACKGROUND

Increasingly, endoscopic techniques such as Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection provide less invasive treatment for early-stage esophageal cancer. However, factors that affect survival after endoscopic resection of esophageal cancer (EREC) are poorly defined. This study aims to build a risk model for patients undergoing EREC, identifying the impact of pathologic risk factors on survival.

METHODS

This retrospective study utilized the National Cancer Database to analyze survival rates of patients with clinically staged T1aN0M0 esophageal cancer who received EREC between 2004 and 2019. Patients treated with chemotherapy/radiation before EREC or surgery after EREC were excluded. The primary outcome was overall survival. Demographic and tumor characteristics were evaluated for their impact on survival. These factors were used in a multivariable analysis to create a risk score, and survival rates were compared across risk scores.

RESULTS

The study analyzed 2169 esophageal cancer patients who underwent EREC. Factors such as age, comorbidity index, and tumor grade were associated with survival. A risk score was developed, which included staging post-EREC, margin status, presence of lymphovascular invasion, histology, and pathologic grade assessment. Increasing risk score was associated with increased risk of death as both a continuous and categorical variable.

CONCLUSIONS

This study evaluated factors affecting survival after EREC. This risk score could be used to identify patients at higher risk of death, thus aiding in patient counseling and treatment planning. Further validation using prospective data are recommended.