Ichiro Oda1, Yuichi Shimizu2, Toshiyuki Yoshio3,4, Chikatoshi Katada5, Tetsuji Yokoyama6, Tomonori Yano7, Haruhisa Suzuki1, Satoshi Abiko8, Kenichi Takemura9, Tomoyuki Koike10, Kohei Takizawa11, Motohiro Hirao12, Hiroyuki Okada13, Takako Yoshii14, Atsushi Katagiri15, Takenori Yamanouchi16, Yasumasa Matsuo17, Hirofumi Kawakubo18, Nozomu Kobayashi19, Tadakazu Shimoda20, Atsushi Ochiai21, Hideki Ishikawa22, Akira Yokoyama23, Manabu Muto24. 1. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan. 2. Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan. 3. Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan. 4. Department of gastroenterology, National Hospital Organization Osaka National Hospital, Osaka, Japan. 5. Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan. 6. Department of Health Promotion, National Institute of Public Health, Wako, Japan. 7. Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan. 8. Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. 9. Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan. 10. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. 11. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan. 12. Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan. 13. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 14. Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan. 15. Department of Medicine, Division of Gastroenterology, Showa University Hospital, Tokyo, Japan. 16. Department of Gastroenterology, Kumamoto Regional Medical Center, Kumamoto, Japan. 17. Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan. 18. Department of Endoscopy Center, Kawasaki Municipal Hospital, Kawasaki, Japan. 19. Department of Gastroenterology, Tochigi Cancer Center, Utsunomiya, Japan. 20. Division of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan. 21. Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Tokyo, Japan. 22. Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan. 23. Clinical Research Unit, National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Japan. 24. Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan.
Abstract
BACKGROUND: Prospectively collected long-term data of patients undergoing endoscopic resection for superficial esophageal squamous cell carcinoma (ESCC) are limited. The aim of this study was to determine the prospectively collected long-term outcomes of endoscopic resection for ESCC as a secondary analysis of the Japan Esophageal Cohort (JEC) study. METHODS: Patients who underwent endoscopic resection of intramucosal ESCC at 16 institutions between September 2005 and May 2010 were enrolled in the JEC study. All patients underwent endoscopic examination with iodine staining at 3 and 6 months after resection, and every 6 months thereafter. We investigated clinical courses after endoscopic resection, survival rates, and cumulative incidence of metachronous ESCC. RESULTS: 330 patients (mean age 67.0 years) with 396 lesions (mean size 20.4 mm) were included in the analysis. Lesions were diagnosed as high-grade intraepithelial neoplasia in 17.4 % and as squamous cell carcinoma in 82.6 % (limited to epithelium in 28.4 %, to lamina propria in 55.4 %, and to muscularis mucosa in 16.2 %). En bloc resection was achieved in 291 (73.5 %). The median follow-up period was 49.4 months. Local recurrences occurred in 13 patients (3.9 %) and were treated by endoscopic procedures. Lymph node metastasis occurred in two patients (0.6 %) after endoscopic resection. The 5-year overall, disease-specific, and metastasis-free survival rates were 95.1 %, 99.1 %, and 94.6 %, respectively. The 5-year cumulative incidence rate of metachronous ESCC was 25.7 %. CONCLUSIONS: Our study demonstrated that endoscopic resection is an effective treatment for intramucosal ESCC, with favorable long-term outcomes. Thieme. All rights reserved.
BACKGROUND: Prospectively collected long-term data of patients undergoing endoscopic resection for superficial esophageal squamous cell carcinoma (ESCC) are limited. The aim of this study was to determine the prospectively collected long-term outcomes of endoscopic resection for ESCC as a secondary analysis of the Japan Esophageal Cohort (JEC) study. METHODS: Patients who underwent endoscopic resection of intramucosal ESCC at 16 institutions between September 2005 and May 2010 were enrolled in the JEC study. All patients underwent endoscopic examination with iodine staining at 3 and 6 months after resection, and every 6 months thereafter. We investigated clinical courses after endoscopic resection, survival rates, and cumulative incidence of metachronous ESCC. RESULTS: 330 patients (mean age 67.0 years) with 396 lesions (mean size 20.4 mm) were included in the analysis. Lesions were diagnosed as high-grade intraepithelial neoplasia in 17.4 % and as squamous cell carcinoma in 82.6 % (limited to epithelium in 28.4 %, to lamina propria in 55.4 %, and to muscularis mucosa in 16.2 %). En bloc resection was achieved in 291 (73.5 %). The median follow-up period was 49.4 months. Local recurrences occurred in 13 patients (3.9 %) and were treated by endoscopic procedures. Lymph node metastasis occurred in two patients (0.6 %) after endoscopic resection. The 5-year overall, disease-specific, and metastasis-free survival rates were 95.1 %, 99.1 %, and 94.6 %, respectively. The 5-year cumulative incidence rate of metachronous ESCC was 25.7 %. CONCLUSIONS: Our study demonstrated that endoscopic resection is an effective treatment for intramucosal ESCC, with favorable long-term outcomes. Thieme. All rights reserved.