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Lu H, Bei Y, Wang C, Deng X, Hu Q, Guo W, Zhang X. A retrospective cohort study to observe the efficacy and safety of Endoscopic Submucosal Dissection (ESD) with adjuvant radiotherapy for T1a-MM/T1b-SM Esophageal Squamous Cell Carcinoma (ESCC). PLoS One 2024; 19:e0298792. [PMID: 38386660 PMCID: PMC10883569 DOI: 10.1371/journal.pone.0298792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND AND AIM The clinical outcome of endoscopy submucosal dissection with subsequent radiotherapy for esophageal squamous cell carcinoma remain unclear. In this study we aim to investigate the efficacy and safety of endoscopic submucosal dissection with adjuvant radiotherapy in the treatment of superficial esophageal squamous cell carcinoma involving the muscularis mucosae (T1a-MM) or the submucosa < 200 μm (T1b-SM1). METHODS We analyzed 20 patients with pathologically confirmed T1a-MM or T1b-SM1 esophageal squamous cell carcinoma treated by endoscopic submucosal dissection from 2016 to 2020 in Lihuili Hospital, 9 patients received adjuvant radiotherapy (RT group) and 11 patients received did not (non-RT group). RESULTS All 20 patients underwent en bloc resection, and both the vertical and horizontal margins were negative. There was no recurrence or lymph node metastasis in the RT group, and no serious complications or death were observed. In the non-RT group, 2 patients had local recurrence and 1 had distant metastasis. None of the 20 patients died of esophageal carcinoma. CONCLUSIONS Adjuvant radiotherapy following endoscopic submucosal dissection may be a safe and effective method for the treatment of T1a-MM/T1b-SM1 superficial esophageal squamous cell carcinoma.
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Affiliation(s)
- Hongna Lu
- Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Yanping Bei
- Department of Radiotherapy, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Chunnian Wang
- Ningbo Clinical and Pathological Diagnosis Center, Ningbo, Zhejiang, China
| | - Xi Deng
- Ningbo Clinical and Pathological Diagnosis Center, Ningbo, Zhejiang, China
| | - QinQin Hu
- Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Wenying Guo
- Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Xuesong Zhang
- Endoscopy Center, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Katada C, Yokoyama T, Hirasawa D, Iizuka T, Kikuchi D, Yano T, Hombu T, Yoshio T, Yoshimizu S, Ono H, Yabuuchi Y, Terai S, Hashimoto S, Takahashi K, Tanaka S, Urabe Y, Arima M, Tanabe S, Wada T, Furue Y, Oyama T, Takahashi A, Sakamoto Y, Muto M. Curative Management After Endoscopic Resection for Esophageal Squamous Cell Carcinoma Invading Muscularis Mucosa or Shallow Submucosal Layer-Multicenter Real-World Survey in Japan. Am J Gastroenterol 2023; 118:1175-1183. [PMID: 36624037 DOI: 10.14309/ajg.0000000000002106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/03/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Curative management after endoscopic resection (ER) for esophageal squamous cell carcinoma (ESCC), which invades the muscularis mucosa (pMM-ESCC) or shallow submucosal layer (pSM1-ESCC), has been controversial. METHODS We identified patients with pMM-ESCC and pSM1-ESCC treated by ER. Outcomes were the predictive factors for regional lymph node and distant recurrence, and survival data were based on the depth of invasion, lymphovascular invasion (LVI), and additional treatment immediately after ER. RESULTS A total of 992 patients with pMM-ESCC (n = 749) and pSM1-ESCC (n = 243) were registered. According to the multivariate Cox proportional hazards analysis, pSM1-ESCC (hazard ratio = 1.88, 95% confidence interval 1.15-3.07, P = 0.012) and LVI (hazard ratio = 6.92, 95% confidence interval 4.09-11.7, P < 0.0001) were associated with a risk of regional lymph node and distant recurrence. In the median follow-up period of 58.6 months (range 1-233), among patients with risk factors (pMM-ESCC with LVI or pSM1-ESCC), the 5-year overall survival rates, relapse-free survival rates, and cause-specific survival rates of patients with additional treatment were significantly better than those of patients without additional treatment; 85.4% vs 61.5% ( P < 0.0001), 80.5% vs 53.3% ( P < 0.0001), and 98.5% vs 93.1% ( P = 0.004), respectively. There was no difference in survival rate between the chemoradiotherapy and surgery groups. DISCUSSION pSM1 and LVI were risk factors for metastasis after ER for ESCC. To improve the survival, additional treatment immediately after ER, such as chemoradiotherapy or surgery, is effective in patients with these risk factors.
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Affiliation(s)
- Chikatoshi Katada
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Real World Data Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tetsuji Yokoyama
- Department of Health Promotion, National Institute of Public Health, Wako, Japan
| | - Dai Hirasawa
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
| | - Toshiro Iizuka
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Daisuke Kikuchi
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takuya Hombu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Shoichi Yoshimizu
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yohei Yabuuchi
- Department of Gastroenterology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Satoru Hashimoto
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Kazuya Takahashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Shinji Tanaka
- Endoscopy and Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Urabe
- Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Miwako Arima
- Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan
| | - Satoshi Tanabe
- Department of Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takuya Wada
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yasuaki Furue
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tsuneo Oyama
- Department of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano, Japan
| | - Akiko Takahashi
- Department of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano, Japan
| | - Yasutoshi Sakamoto
- Kitasato Clinical Research Center, Kitasato University School of Medicine, Sagamihara, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Oncologic significance of lymphovascular invasion in patients with superficial esophageal squamous cell carcinoma reaching the muscularis mucosae or with slight invasion of the submucosa. Surgery 2023; 173:1162-1168. [PMID: 36801078 DOI: 10.1016/j.surg.2022.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/20/2022] [Accepted: 12/24/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND The clinicopathological features and the distribution of lymph node metastasis in patients with T1a-MM and T1b-SM1 superficial esophageal squamous cell carcinoma remain unclear; therefore, the optimal treatment strategy is still controversial. METHODS One hundred and ninety-one patients who had undergone a thoracic esophagectomy with 3-field lymphadenectomy and who were pathologically confirmed to have thoracic superficial esophageal squamous cell carcinoma that had reached the T1a-MM or T1b-SM1 stage were retrospectively reviewed. Risk factors of lymph node metastasis, the distribution of lymph node metastasis, and long-term outcomes were evaluated. RESULTS A multivariate analysis revealed that lymphovascular invasion was the only independent risk factor of lymph node metastasis (odds ratio: 6.410, P < .001). Patients with primary tumors in the middle thoracic region had lymph node metastasis in all 3 fields, whereas patients with primary tumors in the upper or lower thoracic region did not have distant lymph node metastasis. The frequencies of neck (P = .045) and abdominal (P < .001) lymph node metastasis were significantly higher in lymphovascular invasion-positive patients than those in lymphovascular invasion-negative patients in all cohort. MM/lymphovascular invasion-positive patients with middle thoracic tumors had lymph node metastasis spread from the neck to the abdomen. SM1/lymphovascular invasion-negative patients with middle thoracic tumors did not have lymph node metastasis in the abdominal region. The SM1/pN+ group had a significantly poorer overall survival and relapse-free survival than the other groups. CONCLUSION The present study revealed that lymphovascular invasion was associated with not only the frequency of lymph node metastasis, but also the distribution of lymph node metastasis. It also suggested that superficial esophageal squamous cell carcinoma patients with T1b-SM1 and lymph node metastasis had a significantly poorer outcome than those with T1a-MM and lymph node metastasis.
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Ishihara R, Arima M, Iizuka T, Oyama T, Katada C, Kato M, Goda K, Goto O, Tanaka K, Yano T, Yoshinaga S, Muto M, Kawakubo H, Fujishiro M, Yoshida M, Fujimoto K, Tajiri H, Inoue H. Endoscopic submucosal dissection/endoscopic mucosal resection guidelines for esophageal cancer. Dig Endosc 2020; 32:452-493. [PMID: 32072683 DOI: 10.1111/den.13654] [Citation(s) in RCA: 195] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 01/17/2023]
Abstract
The Japan Gastroenterological Endoscopy Society has developed endoscopic submucosal dissection/endoscopic mucosal resection guidelines. These guidelines present recommendations in response to 18 clinical questions concerning the preoperative diagnosis, indications, resection methods, curability assessment, and surveillance of patients undergoing endoscopic resection for esophageal cancers based on a systematic review of the scientific literature.
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Affiliation(s)
- Ryu Ishihara
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Miwako Arima
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Toshiro Iizuka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Tsuneo Oyama
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Motohiko Kato
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kenichi Goda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Osamu Goto
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kyosuke Tanaka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Tomonori Yano
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Manabu Muto
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | | | | | | | - Hisao Tajiri
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Haruhiro Inoue
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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Oguma J, Ozawa S, Kazuno A, Yamamoto M, Ninomiya Y, Yatabe K, Makuuchi H, Ogura G. Prognostic impact of lymphovascular invasion in lymph node-negative superficial esophageal squamous cell carcinoma. Dis Esophagus 2019; 32:5382620. [PMID: 30883635 DOI: 10.1093/dote/doz001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 12/07/2018] [Indexed: 12/11/2022]
Abstract
The relationship between lymphovascular invasion (LVI) and prognosis in patients with superficial esophageal squamous cell carcinoma (SESCC) is unclear. The aim of this study is to evaluate prognostic factors in patients with lymph node-negative SESCC. A total of 195 patients with pathologically confirmed T1a-MM, T1b, and lymph node-negative SESCC were retrospectively reviewed in this study. Overall, the disease-free survival (DFS) rate was poorer in the lymphatic invasion-positive group than in the lymphatic invasion-negative group (p = 0.002) and a multivariate analysis suggested that lymphatic invasion was the only independent prognostic factor of DFS in patients with lymph node-negative SESCC (HR = 4.075, p = 0.005). Distant organ recurrence occurred in one patient (1/52, 1.9%) in the T1b-SM2 group and in six patients (6/61, 9.7%) in the T1b-SM3 group; all of these patients had LVI. LVI-positive patients had a poorer DFS than invasion-negative patients in the T1b-SM2 and SM3 groups (p = 0.026), and a multivariate analysis suggested that LVI was the only independent prognostic factor of DFS in patients with lymph node-negative SM2 and SM3 SESCC (HR = 5.165, p = 0.031). Lymph node-positive patients had a significantly poorer DFS rate than lymph node negative and LVI positive patients among the SM2 and SM3 SESCC patients (p = 0.018). The present results suggested that LVI was an independent prognostic factor in patients with SM2 and SM3 lymph node-negative SESCC; however their prognosis was not worse than that of patients with lymph node-positive SM2 and SM3 SESCC, for whom adjuvant therapy is indicated as a standard treatment.
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Affiliation(s)
- J Oguma
- Department of Gastroenterological Surgery
| | - S Ozawa
- Department of Gastroenterological Surgery
| | - A Kazuno
- Department of Gastroenterological Surgery
| | - M Yamamoto
- Department of Gastroenterological Surgery
| | - Y Ninomiya
- Department of Gastroenterological Surgery
| | - K Yatabe
- Department of Gastroenterological Surgery
| | - H Makuuchi
- Department of Gastroenterological Surgery
| | - G Ogura
- Department of Pathology, Tokai University School of Medicine, Kanagawa, Japan
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Oguma J, Ozawa S, Kazuno A, Yamamoto M, Ninomiya Y, Yatabe K. Prognostic significance of sarcopenia in patients undergoing esophagectomy for superficial esophageal squamous cell carcinoma. Dis Esophagus 2019; 32:5365772. [PMID: 30809629 DOI: 10.1093/dote/doy104] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nononcological prognostic factors in superficial esophageal squamous cell carcinoma (SESCC) patients remain unclear. The aim of this study is to evaluate the relationship between sarcopenia and surgical outcome in patients with SESCC who had undergone definitive surgery. A total of 194 SESCC patients who had undergone thoracic esophagectomy with three-field lymphadenectomy without neoadjuvant therapy at Tokai University Hospital between January 2006 and December 2015 were analyzed retrospectively. Manual tracing using CT imaging was used to measure the cross-sectional areas of the skeletal muscle mass. The cutoff values for the skeletal muscle index used to define sarcopenia were based on the results of a previous study. Twenty-eight patients (14.4%) had sarcopenia, while the remaining 166 patients (85.6%) did not. A multivariate analysis suggested that sarcopenia was an independent risk factor for postoperative pulmonary complications (OR = 3.232, P = 0.026). The overall survival rate and the disease-free survival rate were both significantly worse in the sarcopenia group than in the nonsarcopenia group (P < 0.001). In a multivariate analysis, sarcopenia was an independent prognostic factor affecting overall survival (HR = 7.121, P < 0.001) and disease-free survival (HR = 6.000, P < 0.001). Patients with sarcopenia and lymph node metastasis (n = 18) had a worse outcome than the other patients (P < 0.001). This study suggests that the alleviation of sarcopenia through nutritional support and rehabilitation in SESCC patients scheduled to undergo surgery might help to prevent postoperative pulmonary complications and to improve the long-term outcome.
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Affiliation(s)
- J Oguma
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - S Ozawa
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - A Kazuno
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - M Yamamoto
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Y Ninomiya
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - K Yatabe
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan
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Kadota T, Yano T, Fujita T, Daiko H, Fujii S. Submucosal Invasive Depth Predicts Lymph Node Metastasis and Poor Prognosis in Submucosal Invasive Esophageal Squamous Cell Carcinoma. Am J Clin Pathol 2017; 148:416-426. [PMID: 29069275 DOI: 10.1093/ajcp/aqx093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Lymph node metastasis (LNM) in submucosal invasive esophageal squamous cell carcinoma (SM-ESCC) is a prognostic factor. The aim of this study was to identify a histopathologic predictor of LNM in SM-ESCC. METHODS In total, 108 patients who underwent an esophagectomy and lymph node dissection without preoperative therapy and who were pathologically diagnosed with SM-ESCC were enrolled in this study. Relationships between several clinicopathologic factors and LNM were examined. RESULTS A multivariate analysis revealed that a tumor size of 35 mm or more (P = .0025), submucosal invasive depth (SID) of 2,000 μm or more (P = .013), and lymphatic infiltration (P < .0001) were significant independent predictors of LNM. In addition, there were significant differences in recurrence-free survival curves between patients with SID less than 2,000 μm or not (P = .029) and tumor size less than 35 mm or not (P = .049). CONCLUSIONS This study suggests that SID may predict not only LNM but also poor prognosis.
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Affiliation(s)
| | | | - Takeo Fujita
- Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiroyuki Daiko
- Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Satoshi Fujii
- Division of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Japan
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