Endoscopy 2020; 52(11): 967-975
DOI: 10.1055/a-1185-9329
Original article

Long-term outcome of endoscopic resection for intramucosal esophageal squamous cell cancer: a secondary analysis of the Japan Esophageal Cohort study

Ichiro Oda
 1  Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Yuichi Shimizu
 2  Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
,
Toshiyuki Yoshio
 3  Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
 4  Department of gastroenterology, National Hospital Organization Osaka National Hospital, Osaka, Japan
,
Chikatoshi Katada
 5  Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
,
Tetsuji Yokoyama
 6  Department of Health Promotion, National Institute of Public Health, Wako, Japan
,
Tomonori Yano
 7  Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
,
Haruhisa Suzuki
 1  Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Satoshi Abiko
 8  Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
,
Kenichi Takemura
 9  Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
,
Tomoyuki Koike
10  Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Kohei Takizawa
11  Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
,
Motohiro Hirao
12  Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
,
Hiroyuki Okada
13  Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
,
Takako Yoshii
14  Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
,
Atsushi Katagiri
15  Department of Medicine, Division of Gastroenterology, Showa University Hospital, Tokyo, Japan
,
Takenori Yamanouchi
16  Department of Gastroenterology, Kumamoto Regional Medical Center, Kumamoto, Japan
,
Yasumasa Matsuo
17  Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
,
Hirofumi Kawakubo
18  Department of Endoscopy Center, Kawasaki Municipal Hospital, Kawasaki, Japan
,
Nozomu Kobayashi
19  Department of Gastroenterology, Tochigi Cancer Center, Utsunomiya, Japan
,
Tadakazu Shimoda
20  Division of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan
,
Atsushi Ochiai
21  Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Tokyo, Japan
,
Hideki Ishikawa
22  Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
,
Akira Yokoyama
23  Clinical Research Unit, National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Japan
,
Manabu Muto
24  Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
› Author Affiliations
Trial Registration: UMIN Clinical Trials RegistryRegistration number (trial ID): UMIN000001676 Type of study: prospective, multi-center study


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.

Supplementary material



Publication History

Received: 15 January 2020

Accepted: 06 May 2020

Publication Date:
24 June 2020 (online)

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