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Therapeutic strategies following endoscopic submucosal dissection for T1a-MM/T1b-SM1 esophageal squamous cell carcinoma: comparisons of long-term outcomes with propensity score-matched analysis

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Abstract

Background

For esophageal squamous cell carcinoma (ESCC) invading the muscularis mucosa (T1a-MM) or upper submucosa (T1b-SM1, up to 200 µm), the curative effectiveness of endoscopic submucosal dissection (ESD) and additional therapeutic strategies remain controversial. The present study aims to investigate the effectiveness of ESD followed by different therapeutic strategies in treating such patients.

Methods

A total of 242 patients with T1a-MM/T1b-SM1 ESCCs were involved. Data on therapeutic outcomes and long-term survivals were collected for analysis. Propensity score-matched analysis was performed to compensate for selection bias between patients with no additional therapy (NAT group) and those with additional therapy (AT group).

Results

R0 resection rate was 83.1% and curative resection rate was 78.5%. After a mean follow-up period of 57.8 ± 27.3 months, the cumulative recurrence rate was 7.9%. The 5-year overall survival (OS) and cause-specific survival (CSS) rate was 91.1% and 94.0%. In a matched cohort of 24 pairs, the 5-year OS and CSS rates showed no significant difference between NAT group (82.0% and 87.1%) and AT group (86.0% and 89.9%) (P > 0.05). In the subgroup of patients with noncurative ESD (n = 52), the 5-year OS and CSS rates were significantly higher in surgery group (90.2% and 95.2%) than that in NAT group (50.1% and 59.5%) and chemoradiotherapy group (51.4% and 60.0%) (P < 0.05).

Conclusions

ESD with no additional therapy could achieve favorable long-term outcomes in treating T1a-MM/T1b-SM1 ESCCs. For patients with noncurative ESD, surgery ranks a prime recommendation over CRT.

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Acknowledgements

This work was supported by grants from the National Nature Science Foundation of China (No. 82000622), the Shanghai Municipal Health Commission Scientific Research Project General Program (No. 201940082), and the Shanghai Health Commission Promotion Project for Advanced and Proper Technology (No. 2019SY050).

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Authors and Affiliations

  1. Digestive Endoscopy Center, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Mid Yanchang Road, Shanghai, 200072, China

    Jun Li & Feng Liu

  2. Department of Gastroenterology, Shanghai Tenth People’s Hospital Chongming Branch, Shanghai, China

    Jun Li & Feng Liu

  3. Department of Gastroenterology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China

    Luowei Wang, Xingang Shi, Jie Chen, Zhendong Jin & Zhaoshen Li

  4. Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Duowu Zou

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Contributions

FL: Study conception and design; JL: acquisition, analysis and interpretation of data; JL: drafting of the manuscript; FL: critical revision of the manuscript for important intellectual content; LW, XS, JC, ZJ, DZ: technical or material support; FL, ZL: study supervision. The article has been approved by all authors to be published.

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Correspondence to Zhaoshen Li or Feng Liu.

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Disclosures

Drs. Jun Li, Luowei Wang, Xinggang Shi, Jie Chen, Zhendong Jin, Duowu Zou, Zhaoshen Li and Feng Liu stated that they do not have any conflict of interests or financial ties to disclose.

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464_2022_9683_MOESM2_ESM.tif

Supplementary file2 (TIF 1692 KB) Supplementary Figure 1. Patients flow from the initiation of ESD to death or the last follow-up

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Li, J., Wang, L., Shi, X. et al. Therapeutic strategies following endoscopic submucosal dissection for T1a-MM/T1b-SM1 esophageal squamous cell carcinoma: comparisons of long-term outcomes with propensity score-matched analysis. Surg Endosc 37, 1761–1770 (2023). https://doi.org/10.1007/s00464-022-09683-z

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  • DOI: https://doi.org/10.1007/s00464-022-09683-z

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