Long-term Prognosis for Esophageal Squamous Cell Carcinoma T1bSM2 Treated with Endoscopic Submucosal Dissection Akiko Takahashi 1 , Tsuneo Oyama 1 1Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan Keyword: 食道扁平上皮癌 , T1b-SM2 , ESD , 長期予後 pp.1249-1256
Published Date 2020/9/25
DOI https://doi.org/10.11477/mf.1403202136
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 Forty-seven lesions in forty-seven patients with ESCC(esophageal squamous cell carcinoma)T1bSM2, cN0 who were treated with ESD(endoscopic submucosal dissection)in the period from January 2000 to April 2017 were investigated retrospectively. All the patients could be followed up for at least 3 y.

 The overall rates of recurrence and death associated with ESCC were 2%(1/47)and 2%(1/47), respectively. The 3-year and 5-year cause-specific survival rates were 98% and 98%, respectively. The 3-year and 5-year overall survival rates were 89% and 75%, respectively. There was no vertical margin positive and local recurrence. The rate of local control was 100%.

 The enrolled patients were divided into the high-risk group(lymph duct involvement positive and/or vascular involvement positive)and low-risk group(lymph duct and vascular involvement negative).

 The high-risk group(n=15)had 11 patients who underwent AT(additional treatment)and 4 who did not undergo AT ; the average patient age in these two groups was significantly different(79 y vs. 69 y, respectively, p=0.0182). Only 1 patient(2%)had recurrence and died because of ESCC. There was no significant difference in the recurrence rate and death rate of SCC between patients with and without AT. The 5-year overall survival rates among patients who underwent AT and those who did not undergo AT were 72% and 25%, respectively. The mortality rate was 36%(4/11)and 75%(3/4)among those who did and did not undergo AT, respectively. The 5-year overall survival rate was low because the group that underwent AT had many elderly patients who had a high mortality rate.

 The low-risk group(n=32)had 19 patients who underwent AT and 13 who did not underwent AT. There was no ESCC-related death. There was no significant difference in the age, recurrence rate, SCC-related death rate, and mortality rate between patients who did and did not undergo AT.

 The rate of local control for T1bSM2 treated with ESD was high. ESD alone is a good treatment option, especially in elderly patients with a high mortality rate.

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