Long-term outcomes of endoscopic versus surgical resection for MM-SM1 esophageal squamous cell carcinoma using propensit
- PDF / 911,218 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 44 Downloads / 187 Views
ORIGINAL ARTICLE
Long‑term outcomes of endoscopic versus surgical resection for MM‑SM1 esophageal squamous cell carcinoma using propensity score analysis Kenji Yamauchi1 · Masaya Iwamuro2 · Masahiro Nakagawa3 · Ryuta Takenaka4 · Kazuhiro Matsueda5 · Tomoki Inaba6 · Masao Yoshioka7 · Tatsuya Toyokawa8 · Shouichi Tanaka9 · Hiromitsu Kanzaki2 · Seiji Kawano2 · Yoshiro Kawahara2 · Yasuhiro Shirakawa10 · Hiroyuki Okada2 · Okayama Gut Study Group Received: 9 March 2020 / Accepted: 24 August 2020 © The Japan Esophageal Society 2020
Abstract Background Esophageal squamous cell carcinoma (ESCC) confined to the muscularis mucosae (MM) or up to 200 µm of the submucosa (SM1) confers the risk for lymph node metastasis, and is defined as relative indication for endoscopic submucosal dissection (ESD) by the Japan Esophageal Society guidelines. Although additional surgical treatment after ESD is recommended, long-term outcomes of ESD compared with those of surgery have not been clarified. This study aimed to evaluate the long-term outcomes of ESD and surgery for cN0M0 relative indication lesions of ESCC. Methods Between 2006 and 2016, patients with relative indication lesions of ESCC who underwent ESD or surgery at nine participating hospitals were examined retrospectively. Using propensity score matching, we evaluated survival curves for and hazard ratios associated with endoscopic submucosal dissection and surgery. Results In total, 155 lesions in the ESD group and 106 lesions in the surgery group met the pathological criteria of relative indication for endoscopic resection. After matching, 50 matched pairs of patients who underwent ESD or surgery were selected. The 5-year overall survival rates were 84.5% [95% confidence interval (CI) 68–93] in the ESD group and 79% [95% CI 60–90] in the surgery group. The hazard ratio of mortality for ESD compared with that for surgery estimated by Cox regression analysis was 0.79 (95% CI 0.3–2.06, p = 0.63). Conclusions Compared with surgery, ESD does not compromise long-term outcomes. ESD alone or ESD with chemotherapy and/or radiotherapy may be an option for the treatment of MM and SM1 ESCC. Keywords Esophageal squamous cell carcinoma · Endoscopic submucosal dissection · Surgery · Propensity score
Introduction Esophageal cancer is the sixth most common cause of cancer-related deaths globally [1], and squamous cell carcinoma is the predominant histological type of esophageal neoplasm worldwide [2]. Endoscopic treatment of superficial esophageal squamous cell carcinoma (ESCC) is standard treatment, because improved endoscopic devices are available [3]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10388-020-00775-0) contains supplementary material, which is available to authorized users. * Kenji Yamauchi [email protected] Extended author information available on the last page of the article
Lesions confined to the mucosal epithelium or the lamina propria are rarely associated with lymph node metastasis and are curable by
Data Loading...
