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

Publication History

Received: 15 January 2020

Accepted: 06 May 2020

Article published online:
24 June 2020

• References

• 1 International Agency for Research on Cancer. Cancer fact sheets. Cancer Today. Global Cancer Observatory. Lyon: IARC; 2018
• 2 Tachimori Y, Ozawa S, Numasaki H. Registration Committee for Esophageal Cancer of the Japan Esophageal Society. et al. Comprehensive Registry of Esophageal Cancer in Japan, 2011. Esophagus 2018; 15: 127-152
• 3 Muto M, Minashi K, Yano T. et al. Early detection of superficial squamous cell carcinoma in the head and neck region and esophagus by narrow band imaging: a multicenter randomized controlled trial. J Clin Oncol 2010; 28: 1566-1572
• 4 Katada C, Muto M, Momma K. et al. Clinical outcome after endoscopic mucosal resection for esophageal squamous cell carcinoma invading the muscularis mucosae – a multicenter retrospective cohort study. Endoscopy 2007; 39: 779-783
• 5 Ishihara R, Tanaka H, Iishi H. et al. Long-term outcome of esophageal mucosal squamous cell carcinoma without lymphovascular involvement after endoscopic resection. Cancer 2008; 112: 2166-2172
• 6 Ono S, Fujishiro M, Niimi K. et al. Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc 2009; 70: 860-866
• 7 Kuwano H, Nishimura Y, Oyama T. et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society. Esophagus 2015; 12: 1-30
• 8 Ishihara R, Iishi H, Uedo N. et al. Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan. Gastrointest Endosc 2008; 68: 1066-1072
• 9 Takahashi H, Arimura Y, Masao H. et al. Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc 2010; 72: 255-264
• 10 Yamashina T, Ishihara R, Nagai K. et al. Long-term outcome and metastatic risk after endoscopic resection of superficial esophageal squamous cell carcinoma. Am J Gastroenterol 2013; 108: 544-551
• 11 Tsujii Y, Nishida T, Nishiyama O. et al. Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study. Endoscopy 2015; 47: 775-783
• 12 Nagami Y, Ominami M, Shiba M. et al. The five-year survival rate after endoscopic submucosal dissection for superficial esophageal squamous cell neoplasia. Dig Liver Dis 2017; 49: 427-433
• 13 Katada C, Yokoyama T, Yano T. et al. Alcohol consumption and multiple dysplastic lesions increase risk of squamous cell carcinoma in the esophagus, head, and neck. Gastroenterology 2016; 151: 860-869
• 14 Japan Esophageal Society. Japanese classification of esophageal cancer, 11th Edition. Esophagus 2017; 14: 1-65
• 15 Shimizu Y, Tsukagoshi H, Fujita M. et al. Long-term outcome after endoscopic mucosal resection in patients with esophageal squamous cell carcinoma invading the muscularis mucosae or deeper. Gastrointest Endosc 2002; 56: 387-390
• 16 Araki K, Ohno S, Egashira A. et al. Pathologic features of superficial esophageal squamous cell carcinoma with lymph node and distal metastasis. Cancer 2002; 94: 570-575
• 17 Eguchi T, Nakanishi Y, Shimoda T. et al. Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases. Mod Pathol 2006; 19: 475-480
• 18 Kim DU, Lee JH, Min BH. et al. Risk factors of lymph node metastasis in T1 esophageal squamous cell carcinoma. J Gastroenterol Hepatol 2008; 23: 619-625
• 19 Qi ZP, Chen T, Li B. et al. Endoscopic submucosal dissection for early esophageal cancer in elderly patients with relative indications for endoscopic treatment. Endoscopy 2018; 50: 839-845
• 20 Katada C, Muto M, Manabe T. et al. Local recurrence of squamous-cell carcinoma of the esophagus after EMR. Gastrointest Endosc 2005; 61: 219-225
• 21 Pech O, May A, Gossner L. et al. Curative endoscopic therapy in patients with early esophageal squamous-cell carcinoma or high-grade intraepithelial neoplasia. Endoscopy 2007; 39: 30-35
• 22 Esaki M, Matsumoto T, Hirakawa K. et al. Risk factors for local recurrence of superficial esophageal cancer after treatment by endoscopic mucosal resection. Endoscopy 2007; 39: 41-45
• 23 Guo HM, Zhang XQ, Chen M. et al. Endoscopic submucosal dissection vs endoscopic mucosal resection for superficial esophageal cancer. World J Gastroenterol 2014; 20: 5540-5547
• 24 Slaughter DP, Southwick HW, Smejkal W. “Field cancerization” in oral stratified epithelium. Cancer 1953; 6: 963-968
• 25 Matsubara T, Yamada K, Nakagawa A. Risk of second primary malignancy after esophagectomy for squamous cell carcinoma of the thoracic esophagus. J Clin Oncol 2003; 21: 4336-4341
• 26 Katada C, Yokoyama T, Yano T. et al. Risk of metachronous secondary primary malignancy after endoscopic resection in patients with early esophageal squamous cell carcinoma. Dis Esophagus 2020; DOI: 10.1093/dote/doz110.
• 27 Secretan B, Straif K, Baan R. et al. A review of human carcinogens-part E: tobacco, areca nut, alcohol, coal smoke, and salted fish. Lancet Oncol 2009; 10: 1033-1034
• 28 Berger A, Rahmi G, Perrod G. et al. Long-term follow-up after endoscopic resection for superficial esophageal squamous cell carcinoma: a multicenter Western study. Endoscopy 2019; 51: 298-306
• 29 Lorenzo D, Barret M, Leblanc S. et al. Outcomes of endoscopic submucosal dissection for early oesophageal squamous cell neoplasia at a Western centre. United European Gastroenterol J 2019; 7: 1084-1092