Management decision based on lymphovascular involvement leads to favorable outcomes after endoscopic treatment of esophageal squamous cell carcinoma

Kazuya Takahashi; Satoru Hashimoto; Ken-ichi Mizuno; Takamasa Kobayashi; Kentaro Tominaga; Hiroki Sato; Junji Kohisa; Satoshi Ikarashi; Kazunao Hayashi; Manabu Takeuchi; Junji Yokoyama; Hirokazu Kawai; Yuichi Sato; Masaaki Kobayashi; Shuji Terai

doi:10.1055/s-0043-124433

Endoscopy, Table of Contents

Endoscopy 2018; 50(07): 662-670
DOI: 10.1055/s-0043-124433

Original article

Management decision based on lymphovascular involvement leads to favorable outcomes after endoscopic treatment of esophageal squamous cell carcinoma

Kazuya Takahashi

¹Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

,

Satoru Hashimoto

¹Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

,

Ken-ichi Mizuno

¹Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

,

Takamasa Kobayashi

¹Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

,

Kentaro Tominaga

¹Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

,

Hiroki Sato

²Division of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan

,

Junji Kohisa

¹Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

,

Satoshi Ikarashi

¹Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

,

Kazunao Hayashi

¹Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

,

Manabu Takeuchi

³Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Niigata, Japan

,

Junji Yokoyama

¹Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

,

Hirokazu Kawai

¹Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

,

Yuichi Sato

⁴Department of Gastroenterology, Niigata Prefectural Yoshida Hospital, Niigata, Japan

,

Masaaki Kobayashi

⁵Division of Gastroenterology and Hepatology, Niigata Cancer Center Hospital, Niigata, Japan

,

Shuji Terai

¹Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

› Author Affiliations

Abstract

Background Esophageal squamous cell carcinoma (ESCC) invading the muscularis mucosae (MM) and submucosa up to 200 µm (SM1) has a risk of metastasis. The aims of this study were to investigate the long-term outcome of endoscopic submucosal dissection (ESD) for MM/SM1 ESCC and to assess the management after ESD in our hospital.

Methods This was a retrospective cohort study conducted at a single institution. Patients with MM or SM1 ESCC who were treated with ESD were included. Additional prophylactic therapy was added if lymphovascular involvement (LVI) was noted in the ESD specimens.

Results A total of 102 patients were analyzed. The median length of follow-up was 71.5 months (range 9 – 144 months) and the median number of CTs was 6 (range 0 – 24). LVI was found in 21 patients (20.6 %), and 12 patients underwent additional prophylactic therapy. The 5-year overall survival, disease-specific survival, and tumor-free survival rates were 84.1 %, 97.5 %, and 82.1 %, respectively. A total of 26 patients died, but only 2 of them died from ESCC. The cumulative metastasis rate was 11.8 %, and LVI was a significant predictor of metastasis (hazard ratio 5.42, 95 % confidence interval 1.39 – 21.18; P = 0.02). There were no differences between patients with MM ESCC and those with SM1 ESCC.

Conclusions The long-term outcome after ESD for MM/SM1 ESCC was favorable with additional prophylactic therapy and strict adherence to follow-up. These results indicate that our management decision based on LVI is a valid approach and that ESD can be offered as a therapeutic option to MM/SM1 ESCCs.

Full Text

References

References
1 Oyama T, Tomori A, Hotta K. et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 2005; 3: S67-S70
2 Oda I, Saito D, Tada M. et al. A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 2006; 9: 262-270
3 Fujishiro M, Kodashima S, Goto O. et al. Endoscopic submucosal dissection for esophageal squamous cell neoplasms. Dig Endosc 2009; 21: 109-115
4 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
5 Ancona E, Rampado S, Cassaro M. et al. Prediction of lymph node status in superficial esophageal carcinoma. Ann Surg Oncol 2008; 15: 3278-3288
6 Akutsu Y, Uesato M, Shuto K. et al. The overall prevalence of metastasis in T1 esophageal squamous cell carcinoma: a retrospective analysis of 295 patients. Ann Surg 2013; 257: 1032-1038
7 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
8 Wang S, Chen X, Fan J. et al. Prognostic significance of lymphovascular invasion for thoracic esophageal squamous cell carcinoma. Ann Surg Oncol 2016; 23: 4101-4109
9 Ito E, Ozawa S, Kijima H. et al. New invasive patterns as a prognostic factor for superficial esophageal cancer. J Gastroenterol 2012; 47: 1279-1289
10 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
11 Battafarano RJ. Minimally invasive esophagectomy. Is there an advantage?. Adv Surg 2016; 50: 17-28
12 Ishikura S, Nihei K, Ohtsu A. et al. Long-term toxicity after definitive chemoradiotherapy for squamous cell carcinoma of the thoracic esophagus. J Clin Oncol 2003; 21: 2697-2702
13 Ito H, Itasaka S, Sakanaka K. et al. Long-term complications of definitive chemoradiotherapy for esophageal cancer using the classical method. J Radiat Res 2017; 58: 106-113
14 Shimizu Y, Kato M, Yamamoto J. et al. EMR combined with chemoradiotherapy: a novel treatment for superficial esophageal squamous-cell carcinoma. Gastrointest Endosc 2004; 59: 199-204
15 Ikeda A, Hoshi N, Yoshizaki T. et al. Endoscopic submucosal dissection (ESD) with additional therapy for superficial esophageal cancer with submucosal invasion. Intern Med 2015; 54: 2803-2813
16 Japan Esophageal Society. Japanese Classification of Esophageal Cancer, 11th Edition: part I. Esophagus 2017; 14: 1-36
17 Pech O, May A, Günter E. et al. The impact of endoscopic ultrasound and computed tomography on the TNM staging of early cancer in Barrett’s esophagus. Am J Gastroenterol 2006; 101: 2223-2229
18 Goense L, van Rossum PSN, Reitsma JB. et al. Diagnostic performance of 18F-FDG PET and PET/CT for the detection of recurrent esophageal cancer after treatment with curative intent: a systematic review and meta-analysis. J Nucl Med 2015; 56: 995-1002
19 Yoshii T, Ohkawa S, Tamai S. et al. Clinical outcome of endoscopic mucosal resection for esophageal squamous cell cancer invading muscularis mucosa and submucosal layer. Dis Esophagus 2013; 26: 496-502
20 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
21 Wright CD, Kucharczuk JC, O’Brien SM. et al. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J Thorac Cardiovasc Surg 2009; 137: 587-596
22 Bidoli P, Bajetta E, Stani SC. et al. Ten-year survival with chemotherapy and radiotherapy in patients with squamous cell carcinoma of the esophagus. Cancer 2002; 94: 352-361
23 Hironaka S, Ohtsu A, Boku N. et al. Nonrandomized comparison between definitive chemoradiotherapy and radical surgery in patients with T2-3Nany M0 squamous cell carcinoma of the esophagus. Int J Radiat Oncol Biol Phys 2003; 57: 425-433
24 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
25 Poon RT, Law SY, Chu KM. et al. Multiple primary cancers in esophageal squamous cell carcinoma: incidence and implications. Ann Thorac Surg 1998; 65: 1529-1534

Supplementary Material

Supplementary material