Shinsaku Fukuda1, Atsushi Masamune2, Waku Hatta3, Tomoyuki Koike2, So Takahashi4, Tomohiro Shimada5, Takuto Hikichi6, Yosuke Toya7, Ippei Tanaka8, Yusuke Onozato9, Koichi Hamada10,11, Daisuke Fukushi12, Ko Watanabe13, Shoichi Kayaba14, Hirotaka Ito15, Tatsuya Mikami16, Tomoyuki Oikawa17, Yasushi Takahashi18, Yutaka Kondo19, Tetsuro Yoshimura20, Takeharu Shiroki21, Ko Nagino22, Norihiro Hanabata23, Akira Funakubo24, Dai Hirasawa8, Tetsuya Ohira5, Jun Nakamura6, Takayuki Matsumoto7, Tomohiro Nakamura25, Naoki Nakaya26, Katsunori Iijima4. 1. National University Corporation Hirosaki University, Hirosaki, Japan. 2. Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. 3. Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. waku-style@festa.ocn.ne.jp. 4. Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan. 5. Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan. 6. Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan. 7. Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba, Japan. 8. Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan. 9. Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan. 10. Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan. 11. Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan. 12. Tohoku Medical and Pharmaceutical University School of Medicine, Sendai, Japan. 13. Department of Gastroenterology, Ohara General Hospital, Fukushima, Japan. 14. Department of Gastroenterology, Iwate Prefectural Isawa Hospital, Ohshu, Japan. 15. Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan. 16. Division of Endoscopy, Hirosaki University Hospital, Hirosaki, Japan. 17. Department of Gastroenterology, Miyagi Cancer Center, Natori, Japan. 18. Department of Gastroenterology, National Hospital Organization Sendai Medical Center, Sendai, Japan. 19. Department of Gastroenterology, Tohoku Rosai Hospital, Sendai, Japan. 20. Department of Gastroenterology, Aomori City Hospital, Aomori, Japan. 21. Department of Gastroenterology, Iwate Prefectural Central Hospital, Morioka, Japan. 22. Department of Gastroenterology, Yamagata Prefectural Central Hospital, Yamagata, Japan. 23. Division of Endoscopy, Aomori Prefectural Central Hospital, Aomori, Japan. 24. Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan. 25. Department of Health Record Informatics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan. 26. Department of Health Sciences, Saitama Prefectural University, Koshigaya, Japan.
Abstract
BACKGROUND: We aimed to elucidate the risk of metastatic recurrence after endoscopic resection (ER) without additional treatment for esophageal squamous cell carcinomas (ESCCs) with tumor invasion into the muscularis mucosa (pT1a-MM) or submucosa (T1b-SM). METHODS: We retrospectively enrolled patients with pT1a-MM/pT1b-SM ESCC after ER at 21 institutions in Japan between 2006 and 2017. We compared metastatic recurrence between patients with and without additional treatment, stratified into category A (pT1a-MM with negative lymphovascular invasion [LVI] and vertical margin [VM]), B (tumor invasion into the submucosa ≤ 200 µm [pT1b-SM1] with negative LVI and VM), and C (others). Subsequently, using multivariate Cox analysis, we evaluated risk factors for metastatic recurrence after ER without additional treatment. RESULTS: We enrolled 593 patients, and metastatic recurrence occurred in 38 patients. Metastatic recurrence after additional treatment was significantly lower than that after no additional treatment in category C (9.1% vs. 23.6% in 5 years, p = 0.001), whereas no significant difference was noted in categories A (0.0% vs. 2.6%) and B (0.0% vs. 4.3%). In patients without additional treatment after ER, risk factors for metastatic recurrence were lymphatic invasion (hazard ratio [HR], 5.61), positive VM (HR, 4.55), and tumor invasion into the submucosa > 200 μm (HR, 3.25), and, but near half of the patients with metastatic recurrence had no further recurrence after salvage treatment, resulting in excellent 5-year disease-specific survival in categories A (99.6%) and B (100.0%). CONCLUSIONS: Closed follow-up with no additional treatment may be an acceptable option after ER in pT1a-MM/pT1b-SM1 ESCC with negative LVI and VM.
BACKGROUND: We aimed to elucidate the risk of metastatic recurrence after endoscopic resection (ER) without additional treatment for esophageal squamous cell carcinomas (ESCCs) with tumor invasion into the muscularis mucosa (pT1a-MM) or submucosa (T1b-SM). METHODS: We retrospectively enrolled patients with pT1a-MM/pT1b-SM ESCC after ER at 21 institutions in Japan between 2006 and 2017. We compared metastatic recurrence between patients with and without additional treatment, stratified into category A (pT1a-MM with negative lymphovascular invasion [LVI] and vertical margin [VM]), B (tumor invasion into the submucosa ≤ 200 µm [pT1b-SM1] with negative LVI and VM), and C (others). Subsequently, using multivariate Cox analysis, we evaluated risk factors for metastatic recurrence after ER without additional treatment. RESULTS: We enrolled 593 patients, and metastatic recurrence occurred in 38 patients. Metastatic recurrence after additional treatment was significantly lower than that after no additional treatment in category C (9.1% vs. 23.6% in 5 years, p = 0.001), whereas no significant difference was noted in categories A (0.0% vs. 2.6%) and B (0.0% vs. 4.3%). In patients without additional treatment after ER, risk factors for metastatic recurrence were lymphatic invasion (hazard ratio [HR], 5.61), positive VM (HR, 4.55), and tumor invasion into the submucosa > 200 μm (HR, 3.25), and, but near half of the patients with metastatic recurrence had no further recurrence after salvage treatment, resulting in excellent 5-year disease-specific survival in categories A (99.6%) and B (100.0%). CONCLUSIONS: Closed follow-up with no additional treatment may be an acceptable option after ER in pT1a-MM/pT1b-SM1 ESCC with negative LVI and VM.