Patients With Superficial Esophageal Squamous Cell Cancer With Lymphovascular or Submucosal Invasion Need Additional Therapy After Endoscopic Resection

In patients with esophageal squamous cell carcinoma with invasion into the muscularis mucosa (pMM-ESCC) with lymphovascular invasion (LVI), the Japan Esophageal Society recommends additional treatment through surgery or chemoradiotherapy (CRT) following curative endoscopic resection (ER). The primary aim of this study was to determine predictive factors for regional lymph node and distant recurrence after ER. Survival data were based on the depth of invasion with or without LVI and with or without additional treatment immediately following ER. 

For this retrospective study, patients treated with ER who met the inclusion criteria were selected from 9 sites in Japan. The study included 992 patients (pMM-ESCC, n=749; ESCC with invasion into the upper third of the submucosa [pSM1-ESCC], n=243). Of the patients, the median age was 67 years and 89.5% were male. 

The risk of regional lymph node and distant recurrence after ER was associated with pSM1 (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.15-3.07; P=.012) and LVI (HR, 6.92; 95% CI, 4.05-11.7; P<.0001). Patients receiving additional treatment immediately after ER showed a significant decrease in the risk of recurrence (HR, 0.27; 95% CI, 0.15-0.47; P<.0001). When compared, survival rates (5-year overall survival, relapse-free survival, and cause-specific survival) were significantly higher for those with pMM-ESCC than pSM1-ESCC.