Background and Aims

Lymph node recurrence (LNR) after endoscopic resection (ER) in patients with esophageal squamous cell carcinoma (ESCC) pathologically invading the muscularis mucosae (pMM) without lymphovascular invasion (LVI) has been reported as non-negligible in the ER guidelines for esophageal cancer by the Japan Gastroenterological Endoscopy Society. However, these data were not regarded as high-level evidence because several retrospective case series were tabulated without sufficient long-term follow-up. Hence, this guideline stated that the administration of additional treatment after ER could not be determined for this population. This study aimed to clarify the long-term clinical outcomes after ER of pMM ESCC without LVI.

Methods

Between January 2009 and November 2017, we enrolled followed patients who underwent ER and were diagnosed with pMM ESCC without LVI with no additional treatments. We retrospectively investigated the cumulative recurrence rate and recurrence-free, overall, and disease-specific survival at 5 years after ER.

Results

Eighty-seven patients were enrolled. During the median follow-up period of 64 months (range, 12-117), 3 patients developed lymph node and/or distant recurrence, and 2 of these cases occurred more than 3 years after ER; all 3 patients died of the primary disease. The 5-year cumulative recurrence rate was 4.3%, and the 5-year recurrence-free, disease-specific, and overall survival rates were 88.8%, 98.2%, and 91.7%, respectively.

Conclusions

The long-term outcome for patients with pMM ESCC without LVI was favorable after ER; however, this population had a risk of recurrence directly leading to death. Long-term follow-up is necessary, with attention to the timing of recurrence.

中文翻译：

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食管鳞状细胞癌内镜下切除侵犯黏膜肌层且无淋巴血管侵犯的远期临床疗效

背景和目标

食管鳞状细胞癌 (ESCC) 病理性侵犯黏膜肌层 (pMM) 而无淋巴血管侵犯 (LVI) 的食管鳞状细胞癌 (ESCC) 患者的内镜切除 (ER) 后淋巴结复发 (LNR) 在食管癌 ER 指南中被报告为不可忽视日本消化内镜学会。然而，这些数据不被视为高水平的证据，因为几个回顾性病例系列在没有足够的长期随访的情况下被制成表格。因此，该指南指出，无法确定该人群在 ER 后是否给予额外治疗。本研究旨在阐明无 LVI 的 pMM ESCC ER 后的长期临床结果。

方法

在 2009 年 1 月至 2017 年 11 月期间，我们招募了接受 ER 并被诊断为 pMM ESCC 且没有 LVI 且没有额外治疗的患者。我们回顾性研究了 ER 后 5 年的累积复发率和无复发、总体和疾病特异性生存率。

结果

八十七名患者入组。在 64 个月（范围，12-117）的中位随访期间，3 例患者出现淋巴结和/或远处复发，其中 2 例发生在 ER 后 3 年以上；3例患者均死于原发病。5年累积复发率为4.3%，5年无复发、疾病特异性和总生存率分别为88.8%、98.2%和91.7%。

结论

ER 后无 LVI 的 pMM ESCC 患者的长期预后良好；然而，这个人群有复发直接导致死亡的风险。需要长期随访，注意复发时间。