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Prognostic risk factors associated with esophageal squamous cell carcinoma patients undergoing endoscopic submucosal dissection: a multi-center cohort study

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Abstract

Background

Long-term outcomes of endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma (ESCC) have not been assessed in a large, multicenter cohort. We aimed to evaluate long-term outcomes of ESD for ESCC in a real-world setting.

Methods

We retrospectively recruited 659 patients who underwent ESD for ESCC at ten institutions from January 2007 to December 2015. Of these, 566 patients were analyzed and classified into three groups according to the pathologic invasion depth after ESD: epithelium/lamina propria mucosa (EP/LPM group: 454 patients), muscularis mucosa/submucosa invasion ≤ 200 μm below the inferior margin of the muscularis mucosa (MM/SM1 group: 81 patients), and submucosa invasion > 200 μm below the MM inferior margin (SM2 group: 31 patients).

Results

The 5-year overall survival rates in the EP/LPM, MM/SM1, and SM2 groups were 92.6%, 80.0%, and 62.7%, respectively, while the 5-year disease-specific survival rates were 99.7%, 96.9%, and 88.3%, respectively. Multivariate analyses revealed that the invasion depth, Charlson Comorbidity Index (CCI), and prognostic nutritional index (PNI) were independent prognostic factors. Hazard ratios in the MM/SM1 and SM2 groups were 2.25 (95% confidence interval [CI] 1.04–4.83; P = 0.038) and 3.18 (95% CI 1.08–9.34; P = 0.036), respectively, compared to those in the EP/LPM group, while those for patients with a CCI ≥ 3 and PNI ≤ 47.75 were 3.25 (95% CI 1.79–5.89; P < 0.001) and 2.42 (95% CI 1.26–4.65; P = 0.008), respectively.

Conclusions

This study identified that invasion depth, presence of comorbid diseases and preoperative nutritional status are independent prognostic risk factors associated with ESCC patients undergoing ESD.

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Acknowledgements

We thank all members of the KESG. We are also grateful to the following investigators: Tsugitaka Ishida, Yuka Azuma, Hiroaki Kitae, Shinya Matsumura, Kazuyuki Ogita, Shun Takayama, Naoki Mizuno (Kyoto Prefectural University of Medicine), and Takahiro Nakano (Japanese Red Cross Society Kyoto Daiichi Hospital) for their help with the data collection.

Funding

This work was partly supported by Grants-in-Aid for JFE (The Japanese Foundation for Research and Promotion of Endoscopy) Grant to Osamu Dohi and Cancer Research Grant from Kyoto Preventive Medical Center to Naoto Iwai.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan

    Naoto Iwai

  2. Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan

    Naoto Iwai, Osamu Dohi, Takeshi Yasuda, Yuji Naito & Yoshito Itoh

  3. Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan

    Shinya Yamada & Hiroyuki Kimura

  4. Department of Gastroenterology, North Medical Center, Kyoto Prefectural University of Medicine, Yosanocho, Kyoto, Japan

    Akihito Harusato

  5. Department of Gastroenterology, JCHO Kyoto Kuramaguchi Medical Center, Kyoto, Japan

    Ryusuke Horie

  6. Department of Gastroenterology, Asahi University Hospital, Gifu, Japan

    Takeshi Yasuda & Nobuaki Yagi

  7. Department of Gastroenterology, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan

    Nobuhisa Yamada

  8. Department of Gastroenterology, Medical Corporation Keishinkai, Kyoto Kizugawa Hospital, Joyo, Kyoto, Japan

    Yusuke Horii

  9. Department of Gastroenterology and Hepatology, Omihachiman Community Medical Center, Omihachiman, Shiga, Japan

    Atsushi Majima

  10. Department of Gastroenterology and Hepatology, Otsu City Hospital, Otsu, Shiga, Japan

    Keika Zen

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  1. Naoto Iwai
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  14. Yoshito Itoh
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Corresponding author

Correspondence to Osamu Dohi.

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Disclosures

Naoto Iwai, Osamu Dohi, Shinya Yamada, Akihito Harusato, Ryusuke Horie, Takeshi Yasuda, Nobuhisa Yamada, Yusuke Horii, Atsushi Majima, Keika Zen, Hiroyuki Kimura, Nobuaki Yagi, Yuji Naito, and Yoshito Itoh have no conflicts of interest or financial ties to disclose.

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Iwai, N., Dohi, O., Yamada, S. et al. Prognostic risk factors associated with esophageal squamous cell carcinoma patients undergoing endoscopic submucosal dissection: a multi-center cohort study. Surg Endosc 36, 2279–2289 (2022). https://doi.org/10.1007/s00464-021-08502-1

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  • DOI: https://doi.org/10.1007/s00464-021-08502-1

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