Abstract
ObjectiveTo evaluate the outcome following the strategy of endoscopic R0 resection (ER) plus adjuvant treatment (AT) versus esophagectomy for esophageal squamous cell cancer in T1a invading muscularis mucosa (M3)-T1b stage.MethodsWe evaluated the outcomes of 46 esophageal squamous cell cancer (ESCC) patients with T1aM3-T1b stage who underwent ER + AT from the Esophageal Cancer Endoscopic Therapy Consortium (ECETC) and compared these outcomes to 92 patients who underwent esophagectomy. Propensity score matching (1:2) was used, with overall survival (OS) and relapse-free survival (RFS) being compared between the two groups.ResultsDuring a median follow-up of 32 months, there were no statistical differences (P = 0.226) in OS between the two groups. The 1-, 2-, and 3-year overall survival in the esophagectomy group was 95%, 91%, and 84%, respectively. There were no mortalities within three years in the ER + AT group. The RFS between the two groups was also not significantly different (P = 0.938). The 1-, 2-, and 3-year RFS of patients in the esophagectomy group was 90%, 90%, and 83%, respectively, while it was 97%, 94%, and 74% in the ER + AT group, respectively. The local recurrence rates between the two groups were not significantly different (P = 0.277).ConclusionsThis first multicenter analysis showed similar outcomes were found regarding OS and RFS between the two groups in T1aM3-T1b stage patients. ER + AT may be considered in high-risk patients or for those who refuse esophagectomy.
Highlights
Endoscopic resection alone might not be enough for patients with T1am3-T1b esophageal cancer mainly due to inadequate resection and unremoved positive lymph nodes, which are significantly related to more reduced survival
Our preliminary data demonstrated Tm3/ sm1 patient who underwent endoscopic resection alone had worse survival compared with esophagectomy
Investigators have been trying for years to find the risk factors that can predict lymph node metastasis [22,23,24,25], and those were found to predict high risk are recommended for an indication of esophagectomy
Summary
Endoscopic resection (ER) is recommended for selected patients with low-risk characteristics who have early-stage cancer without evidence of lymph node metastasis. This first multicenter study was conducted to evaluate the outcomes following the strategy of ER + AT for esophageal cancer in the T1aM3-T1b stage versus esophagectomy. Forty-six patients with esophageal cancer in early stages were included in this study as the ER + AT group.
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