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The characteristics and prognostic significance of esophageal squamous cell carcinoma with synchronous multiple lesions: over 10-year experience

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Abstract

Purpose

Esophageal squamous cell carcinoma (ESCC) is occasionally observed with synchronous multiple tumor lesions. Our study is aiming to define the clinical and prognostic features of this pathological subtype.

Methods

This study included a large cohort of 1126 ESCC patients received esophagectomy with systemic lymph-node dissection between 2003 and 2013 in Sun Yat-sen University Cancer Center. The characteristics and prognostic significance of ESCC with multiple lesions were analyzed. The propensity score matching was performed to balance the baseline clinical characteristics.

Results

A total of 103 patients (9.1%) with 216 synchronous multiple lesions were identified from postoperative gross samples. Among them, 94 patients had two lesions, and 8 patients had three lesions, while only one patient had four lesions. The consistency of pT stages and histological grade among tumor lesions from the same gross sample were 19.4% (20/103) and 37.9% (39/103), respectively. Additionally, the tumor sites, sizes, and even the pathological subtypes can be variant in one patient. The preoperative upper gastrointestinal endoscopy could only identified 80.1% of the multiple tumor lesions. The male gender (P = 0.012), positive personal cancer history (P < 0.001), and higher pN stages (P < 0.001) were independent risk factors for synchronous multiple lesions. Patients with multiple lesions showed significantly lower survival rate (P = 0.002), and the multiple-lesion was an independently adverse prognostic factor in operable ESCC (P = 0.002).

Conclusion

ESCC with multiple lesions had unique clinical features and should not be simply treated as the one-lesion ESCC. Due to its worse prognostic impact, advanced multidisciplinary therapies should be considered for patients with multiple esophageal tumor lesions.

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Acknowledgements

Dr. JY Chen would like to thank her husband for the unconditional love and support, so that she is able to spend most of the after work hours on studies. Therefore, the birthday of her husband was chosen as the seed number of PSM to support the study.

Author information

Author notes

  1. Jun-Ying Chen, Shui-Shen Zhang, Xia-Yu Fu, and Jing Wen contributed equally to this work and therefore share the first co-authorship.

Authors and Affiliations

  1. Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China

    Jun-Ying Chen, Jing Wen, Hong Yang, Jian-Hua Fu & Qian-Wen Liu

  2. Guangdong Esophageal Cancer Institute, Guangzhou, China

    Jun-Ying Chen, Jing Wen, Hong Yang, Jian-Hua Fu & Qian-Wen Liu

  3. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China

    Jun-Ying Chen, Jing Wen, Hong Yang, Jian-Hua Fu & Qian-Wen Liu

  4. Department of Thoracic Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

    Shui-Shen Zhang & Xia-Yu Fu

  5. Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, China

    Yi-Jun Zhang

Authors
  1. Jun-Ying Chen
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  2. Shui-Shen Zhang
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Contributions

JYC designed the work. QWL retrospectively enrolled patients and interpreted the data. JHF approved the version to be published. JYC, SSZ, and XYF contributed to data analysis. JYC, JW, HY, and YJZ contributed to manuscript writing.

Corresponding authors

Correspondence to Jian-Hua Fu or Qian-Wen Liu.

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Ethical Statement

The study was approved by the IRB of Sun Yat-sen University Cancer Center and patient’s consent was waived.

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No author reported any conflict of interest.

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Chen, JY., Zhang, SS., Fu, XY. et al. The characteristics and prognostic significance of esophageal squamous cell carcinoma with synchronous multiple lesions: over 10-year experience. Esophagus 18, 851–860 (2021). https://doi.org/10.1007/s10388-021-00856-8

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  • DOI: https://doi.org/10.1007/s10388-021-00856-8

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