Comparative analysis of endoscopic R0 resection followed by additional chemoradiotherapy for early stage esophageal cancer compared with esophagectomy: A multi-center study from ECETC_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUANG Binhao ¹ , WANG Shengfei ¹ , LIU Zhiguo ² , LI Zhigang ³ , LUO Kongjia ⁴ , BAI Jianying ⁵ , PENG Xue ⁵ , LIU Xiaofeng ¹ , WEI Zhi ⁶ , JIN Peng ⁷ , CHEN Yanyan ⁸ , XIAGN Jiaqing ¹ , ZHANG Yawei ¹ , CHEN Sufeng ¹ , XIE Juntao ¹ , ZHUGE Lingdun ¹ , CHEN Haiquan ¹ ,  ZHANG Jie ^1,9

1. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, P.R.China;
2. Department of Gastroenterology, Xijing Hospital, Xian, 710000, P.R.China;
3. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, 200030, P.R.China;
4. Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, 510000, P.R.China;
5. Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, P.R.China;
6. Department of Gastroenterology, Jinan Military General Hospital, Jinan, 250000, P.R.China;
7. Department of Gastroenterology, Wuhan General Hospital of Guangzhou Military, Guangzhou, 510000, P.R.China;
8. Department of Respiratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, 200030, P.R.China;
9. Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA;

Corresponding author：

ZHANG Jie, Email: zhangjie2289@hotmail.com

Keywords：

Esophageal neoplasms; endoscopic resection; adjuvant radiotherapy; adjuvant chemotherapy; esophagectomy; propensity score

DOI：

10.7507/1007-4848.201803029

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the strategy of chemoradiotherapy following endoscopic R0 resection for esophageal cancer in M3-T1b stage. Methods There were 45 esophageal cancer patients with M3-T1b stage with endoscopic R0 resection followed by additional chemoradiotherapy from ECETC (Esophageal Cancer Endoscopic Therapy Consortium) as a trial group with 34 males and 11 females at age of 61.37±7.14 years. There were 90 patients with esophagectomy from Fudan University Shanghai Cancer Center as a control group with 63 males and 27 females at age of 61.04±8.17 years. Propensity score match (1:2) was used to balance the factors: gender, age, position, depth of invasion and lymphovascular invasion (LVI), which may influence the outcomes. Overall survival (OS) rate, relapse free survival (RFS) rate, and local recurrence rate were compared between the two groups. Result There was no statistical difference (HR=2.66 with 95%CI 0.87 to 8.11, P=0.179) in terms of OS rate between the two groups. One, two and three years overall survival rate of patients in the control group was 93%, 86%, and 84%, respectively. Nobody died in the trial group within 3 years after surgery. The RFS rate between the two groups didn’t significantly differ (HR=1.48, 95% CI 0.66 to 3.33, P=0.389). One, two and three years RFS rate of patients in the contorl group was 87%, 78%, and 76%, respectively, while 97%, 93%, and 73% in the trial group, respectively. The local recurrence rates between the two groups didn’t significantly differ either ( HR=0.53, 95%CI 0.13 to 2.18, P=0.314). One, two and three years local recurrence rate of patients in the control group was 5%, 6% and 6%, respectively, while 0%, 0% and 21% in the trial group, respectively. Conclusion Similar outcomes are found regarding OS, RFS and local recurrence rates between the two groups. The strategy of endoscopic R0 resection followed by additional chemoradiotherapy has prospect for the treatment of esophageal cancer in M3-T1b stage. And this kind of therapy may be provided for those with risk factors or can not tolerate surgery.

Citation： HUANG Binhao, WANG Shengfei, LIU Zhiguo, LI Zhigang, LUO Kongjia, BAI Jianying, PENG Xue, LIU Xiaofeng, WEI Zhi, JIN Peng, CHEN Yanyan, XIAGN Jiaqing, ZHANG Yawei, CHEN Sufeng, XIE Juntao, ZHUGE Lingdun, CHEN Haiquan, ZHANG Jie. Comparative analysis of endoscopic R0 resection followed by additional chemoradiotherapy for early stage esophageal cancer compared with esophagectomy: A multi-center study from ECETC. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(6): 466-470. doi: 10.7507/1007-4848.201803029 Copy

1.	Manner H, May A, Pech O, et al. Early Barrett's carcinoma with "low-risk" submucosal invasion: long-term results of endoscopic resection with a curative intent. Am J Gastroenterol, 2008; 103(10): 2589-2597.
2.	Urabe Y, Hiyama T, Tanaka S, et al. Advantages of endoscopic submucosal dissection versus endoscopic oblique aspiration mucosectomy for superficial esophageal tumors. J Gastroenterol Hepatol, 2011, 26(2): 275-280.
3.	Oyama T, Tomori A, Hotta K, et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol, 2005, 3(7 Suppl 1): S67-S70.
4.	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(6): 1032-1038.
5.	Sgourakis G, Gockel I, Lang H. Endoscopic and surgical resection of T1a/T1b esophageal neoplasms: a systematic review. World J Gastroenterol, 2013, 19(9): 1424-1437.
6.	Wu J, Chen QX, Shen DJ, et al. A prediction model for lymph node metastasis in T1 esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg, 2018, 155(4): 1902-1908.
7.	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(2): 199-204.
8.	Kawaguchi G, Sasamoto R, Abe E, et al. The effectiveness of endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer. Radiat Oncol, 2015, 10: 31.
9.	Hisano O, Nonoshita T, Hirata H, et al. Additional radiotherapy following endoscopic submucosal dissection for T1a-MM/T1b-SM esophageal squamous cell carcinoma improves locoregional control. Radiat Oncol, 2018, 13(1): 14.
10.	Higuchi K, Tanabe S, Koizumi W, et al. Expansion of the indications for endoscopic mucosal resection in patients with superficial esophageal carcinoma. Endoscopy, 2007, 39(1): 36-40.
11.	Altorki NK, Lee PC, Liss Y, et al. Multifocal neoplasia and nodal metastases in T1 esophageal carcinoma: implications for endoscopic treatment. Ann Surg, 2008, 247(3): 434-439.
12.	Cen P, Hofstetter WL, Lee JH, et al. Value of endoscopic ultrasound staging in conjunction with the evaluation of lymphovascular invasion in identifying low-risk esophageal carcinoma. Cancer, 2008,; 112(3): 503-510.
13.	Wani S, Drahos J, Cook MB, et al. Comparison of endoscopic therapies and surgical resection in patients with early esophageal cancer: a population-based study. Gastrointest Endosc, 2014, 79(2): 224-232. e1.
14.	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(2): 255-64, 264. e1-2.
15.	Okada K, Tsuchida T, Ishiyama A, et al. Endoscopic mucosal resection and endoscopic submucosal dissection for en bloc resection of superficial pharyngeal carcinomas. Endoscopy, 2012, 44(6): 556-564.
16.	Spechler SJ. Dysplasia in Barrett's esophagus: limitations of current management strategies. Am J Gastroenterol, 2005, 100(4): 927-935.
17.	Chu JN, Choi J, Tramontano A, et al. Surgical vs endoscopic management of T1 esophageal adenocarcinoma: A modeling decision analysis. Clin Gastroenterol Hepatol, 2018, 16(3): 392-400. e7.

1. Manner H, May A, Pech O, et al. Early Barrett's carcinoma with "low-risk" submucosal invasion: long-term results of endoscopic resection with a curative intent. Am J Gastroenterol, 2008; 103(10): 2589-2597.
2. Urabe Y, Hiyama T, Tanaka S, et al. Advantages of endoscopic submucosal dissection versus endoscopic oblique aspiration mucosectomy for superficial esophageal tumors. J Gastroenterol Hepatol, 2011, 26(2): 275-280.
3. Oyama T, Tomori A, Hotta K, et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol, 2005, 3(7 Suppl 1): S67-S70.
4. 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(6): 1032-1038.
5. Sgourakis G, Gockel I, Lang H. Endoscopic and surgical resection of T1a/T1b esophageal neoplasms: a systematic review. World J Gastroenterol, 2013, 19(9): 1424-1437.
6. Wu J, Chen QX, Shen DJ, et al. A prediction model for lymph node metastasis in T1 esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg, 2018, 155(4): 1902-1908.
7. 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(2): 199-204.
8. Kawaguchi G, Sasamoto R, Abe E, et al. The effectiveness of endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer. Radiat Oncol, 2015, 10: 31.
9. Hisano O, Nonoshita T, Hirata H, et al. Additional radiotherapy following endoscopic submucosal dissection for T1a-MM/T1b-SM esophageal squamous cell carcinoma improves locoregional control. Radiat Oncol, 2018, 13(1): 14.
10. Higuchi K, Tanabe S, Koizumi W, et al. Expansion of the indications for endoscopic mucosal resection in patients with superficial esophageal carcinoma. Endoscopy, 2007, 39(1): 36-40.
11. Altorki NK, Lee PC, Liss Y, et al. Multifocal neoplasia and nodal metastases in T1 esophageal carcinoma: implications for endoscopic treatment. Ann Surg, 2008, 247(3): 434-439.
12. Cen P, Hofstetter WL, Lee JH, et al. Value of endoscopic ultrasound staging in conjunction with the evaluation of lymphovascular invasion in identifying low-risk esophageal carcinoma. Cancer, 2008,; 112(3): 503-510.
13. Wani S, Drahos J, Cook MB, et al. Comparison of endoscopic therapies and surgical resection in patients with early esophageal cancer: a population-based study. Gastrointest Endosc, 2014, 79(2): 224-232. e1.
14. 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(2): 255-64, 264. e1-2.
15. Okada K, Tsuchida T, Ishiyama A, et al. Endoscopic mucosal resection and endoscopic submucosal dissection for en bloc resection of superficial pharyngeal carcinomas. Endoscopy, 2012, 44(6): 556-564.
16. Spechler SJ. Dysplasia in Barrett's esophagus: limitations of current management strategies. Am J Gastroenterol, 2005, 100(4): 927-935.
17. Chu JN, Choi J, Tramontano A, et al. Surgical vs endoscopic management of T1 esophageal adenocarcinoma: A modeling decision analysis. Clin Gastroenterol Hepatol, 2018, 16(3): 392-400. e7.

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Comparative analysis of endoscopic R0 resection followed by additional chemoradiotherapy for early stage esophageal cancer compared with esophagectomy: A multi-center study from ECETC

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