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Additional Treatment Following Noncurative Endoscopic Resection for Esophageal Squamous Cell Carcinoma: A Comparison of Outcomes between Esophagectomy and Chemoradiotherapy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Endoscopic resection (ER) has been widely implemented for cT1N0 esophageal squamous cell carcinoma (ESCC). Additional therapy, including esophagectomy and chemoradiotherapy (CRT), is sometimes required after noncurative ER.

Methods

We retrospectively reviewed 108 patients who received any additional treatment following noncurative ER (positive vertical margins, lymphovascular invasion, or invasion depth of submucosa or more), and compared the short- and long-term outcomes between the two treatment modalities.

Results

Of 108 patients, 56 underwent esophagectomy (E group), and 52 received CRT (CRT group). A positive vertical margin was observed in 17 (14.8%) patients and high risks of occult lymph node metastasis were observed in 91 (85.2%) patients, as well as lymphovascular invasion in 35 (32.4%) patients, invasion depth of the submucosa or more in 27 (25.0%) patients, and both in 29 (26.9%) patients. The E group patients were significantly younger (p = 0.046) and tended to present with larger tumors than those in the CRT group (p = 0.057). Lymphatic invasion was more frequent in the E group (p = 0.019), and, furthermore, one treatment-related death was observed in the E group. There were no significant differences between the groups in overall and disease-specific survival (p = 0.406 and 0.151, respectively), however, recurrence was only observed in the CRT group.

Conclusion

Both esophagectomy and CRT are safe and effective as additional treatments after noncurative ER in patients with ESCC. Esophagectomy is oncologically safe, whereas a risk of postoperative morbidity and mortality remains. Although the adverse events are acceptable, CRT has a certain degree of risk of disease recurrence.

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References

  1. Pennathur A, Gibson MK, Jobe BA, Luketich JD. Oesophageal carcinoma. Lancet. 2013;381(9864):400–12.

    Article  Google Scholar 

  2. Smyth EC, Lagergren J, Fitzgerald RC, et al. Oesophageal cancer. Nat Rev Dis Primers. 2017;3:17048.

    Article  Google Scholar 

  3. Lagergren J, Smyth E, Cunningham D, Lagergren P. Oesophageal cancer. Lancet. 2017;390(10110):2383–96.

    Article  Google Scholar 

  4. Muto M, Minashi K, Yano T, et al. Early detection of superficial squamous cell carcinoma in the head and neck region and esophagus by narrow band imaging: a multicenter randomized controlled trial. J Clin Oncol. 2010;28(9):1566–72.

    Article  Google Scholar 

  5. Berger A, Rahmi G, Perrod G, et al. Long-term follow-up after endoscopic resection for superficial esophageal squamous cell carcinoma: a multicenter Western study. Endoscopy. 2019;51(4):298–306.

    Article  Google Scholar 

  6. Watanabe M, Otake R, Kozuki R, et al. Recent progress in multidisciplinary treatment for patients with esophageal cancer. Surg Today. 2020;50(1):12–20.

    Article  Google Scholar 

  7. Akutsu Y, Uesato M, Shuto K, et al. The overall prevalence of metastasis in T1 esophageal squamous cell carcinoma: a retrospective analysis of 295 patients. Ann Surg. 2013;257(6):1032–8.

    Article  Google Scholar 

  8. Eguchi T, Nakanishi Y, Shimoda T, et al. Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases. Mod Pathol. 2006;19(3):475–80.

    Article  Google Scholar 

  9. Kato K, Igaki H, Ito Y, et al. Parallel-group controlled trial of esophagectomy versus chemoradiotherapy in patients with clinical stage I esophageal carcinoma (JCOG0502). J Clin Oncol. 2019;37(4 Suppl).

  10. Saeki H, Watanabe M, Mine S, et al. Esophagectomy for superficial esophageal cancer after non-curative endoscopic resection. J Gastroenterol. 2015;50(4):406–13.

    Article  Google Scholar 

  11. Maruyama S, Okamura A, Imamura Y, et al. Comparison of outcomes between additional esophagectomy after noncurative endoscopic resection and upfront esophagectomy for T1N0 esophageal squamous cell carcinoma. Ann Surg Oncol. 2021. https://doi.org/10.1245/s10434-020-09498-z.

    Article  PubMed  Google Scholar 

  12. Kawaguchi G, Sasamoto R, Abe E, et al. The effectiveness of endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer. Radiat Oncol. 2015;10:31.

    Article  CAS  Google Scholar 

  13. Yoshimizu S, Yoshio T, Ishiyama A, et al. Long-term outcomes of combined endoscopic resection and chemoradiotherapy for esophageal squamous cell carcinoma with submucosal invasion. Dig Liver Dis. 2018;50(8):833–8.

    Article  Google Scholar 

  14. Minashi K, Nihei K, Mizusawa J, et al. Efficacy of endoscopic resection and selective chemoradiotherapy for stage I esophageal squamous cell carcinoma. Gastroenterology. 2019;157(2):382-390.e383.

    Article  Google Scholar 

  15. Ikeda A, Hoshi N, Yoshizaki T, et al. Endoscopic submucosal dissection (ESD) with additional therapy for superficial esophageal cancer with submucosal invasion. Intern Med. 2015;54(22):2803–13.

    Article  Google Scholar 

  16. Koterazawa Y, Nakamura T, Oshikiri T, et al. A comparison of the clinical outcomes of esophagectomy and chemoradiotherapy after noncurative endoscopic submucosal dissection for esophageal squamous cell carcinoma. Surg Today. 2018;48(8):783–9.

    Article  CAS  Google Scholar 

  17. Tanaka T, Ueno M, Iizuka T, et al. Comparison of long-term outcomes between esophagectomy and chemoradiotherapy after endoscopic resection of submucosal esophageal squamous cell carcinoma. Dis Esophagus. 2019;32(12):1–8.

    CAS  Google Scholar 

  18. Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 1. Esophagus. 2019;16(1):1–24.

    Article  Google Scholar 

  19. Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan esophageal society: part 2. Esophagus. 2019;16(1):25–43.

    Article  Google Scholar 

  20. Brierley JDGM, Wittekind C (eds). TNM classification of malignant tumors. International Union Against Cancer. 8th ed. Oxford: Wiley; 2017.

  21. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

    Article  CAS  Google Scholar 

  22. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.

    Article  Google Scholar 

  23. Common Terminology Criteria for adverse Events v. 5.0. 2017. Available at: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf. Accessed 27 Nov 2017.

  24. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.

    Article  CAS  Google Scholar 

  25. Kato H, Sato A, Fukuda H, et al. A phase II trial of chemoradiotherapy for stage I esophageal squamous cell carcinoma: Japan Clinical Oncology Group Study (JCOG9708). Jpn J Clin Oncol. 2009;39(10):638–43.

    Article  Google Scholar 

  26. Ando N, Iizuka T, Ide H, et al. Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus: a Japan Clinical Oncology Group Study–JCOG9204. J Clin Oncol. 2003;21(24):4592–6.

    Article  Google Scholar 

  27. Takeuchi H, Miyata H, Gotoh M, et al. A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg. 2014;260(2):259–66.

    Article  Google Scholar 

  28. Elliott JA, Docherty NG, Eckhardt HG, et al. Weight loss, satiety, and the postprandial gut hormone response after esophagectomy: a prospective study. Ann Surg. 2017;266(1):82–90.

    Article  Google Scholar 

  29. Ito H, Itasaka S, Sakanaka K, Araki N, Mizowaki T, Hiraoka M. Long-term complications of definitive chemoradiotherapy for esophageal cancer using the classical method. J Radiat Res. 2017;58(1):106–13.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Yasukazu Kanie MD, Akihiko Okamura MD, PhD, Suguru Maruyama MD, PhD, Kei Sakamoto MD, Daisuke Fujiwara MD, PhD, Jun Kanamori MD, PhD, Yu Imamura MD, PhD, FACS & Masayuki Watanabe MD, PhD, FACS

  2. Department of Radiation Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Takao Asari MD

  3. Department of Gastroenterological Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Akiyoshi Ishiyama MD, Toshiyuki Yoshio MD, PhD, Tomohiro Tsuchida MD, PhD & Keisho Chin MD

Authors
  1. Yasukazu Kanie MD
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  2. Akihiko Okamura MD, PhD
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  3. Takao Asari MD
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  4. Suguru Maruyama MD, PhD
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  8. Yu Imamura MD, PhD, FACS
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  9. Akiyoshi Ishiyama MD
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  13. Masayuki Watanabe MD, PhD, FACS
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Corresponding author

Correspondence to Akihiko Okamura MD, PhD.

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Disclosure

Keisho Chin reports grants and personal fees from Ono Pharmaceutical Co. Ltd, Taiho Pharmaceutical Co. Ltd, and Chugai Pharmaceutical Co. Ltd, outside this work. Yasukazu Kanie, Akihiko Okamura, Takao Asari, Suguru Maruyama, Kei Sakamoto, Daisuke Fujiwara, Jun Kanamori, Yu Imamura, Akiyoshi Ishiyama, Toshiyuki Yoshio, Tomohiro Tsuchida, and Masayuki Watanabe have no conflicts of interest to declare.

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10434_2021_10225_MOESM1_ESM.eps

Supplementary Fig. 1. Time to recurrence of patients with or without any additional treatment. ER endoscopic resection (EPS 5497 kb)

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Kanie, Y., Okamura, A., Asari, T. et al. Additional Treatment Following Noncurative Endoscopic Resection for Esophageal Squamous Cell Carcinoma: A Comparison of Outcomes between Esophagectomy and Chemoradiotherapy. Ann Surg Oncol 28, 8428–8435 (2021). https://doi.org/10.1245/s10434-021-10225-5

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