Combined assessment of clinical and pathological prognostic factors for deciding treatment strategies for esophageal squamous cell carcinoma invading into the muscularis mucosa or submucosa after endoscopic submucosal dissection
Objectives We aimed to clarify the prognostic factors for patients with esophageal squamous cell carcinoma (ESCC) invading into the muscularis mucosa (pT1a‐MM) or submucosa (pT1b‐SM) after endoscopic submucosal dissection (ESD). Methods This retrospective study enrolled such patients at 21 instituti...
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| Veröffentlicht in: | Digestive endoscopy 2022-11, Vol.34 (7), p.1382-1391 |
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| creator | Shimada, Tomohiro Hatta, Waku Takahashi, So Koike, Tomoyuki Ohira, Tetsuya Hikichi, Takuto Toya, Yosuke Tanaka, Ippei Onozato, Yusuke Hamada, Koichi Fukushi, Daisuke Watanabe, Ko Kayaba, Shoichi Ito, Hirotaka Mikami, Tatsuya Oikawa, Tomoyuki Takahashi, Yasushi Kondo, Yutaka Yoshimura, Tetsuro Shiroki, Takeharu Nagino, Ko Hanabata, Norihiro Funakubo, Akira Nakamura, Jun Matsumoto, Takayuki Iijima, Katsunori Fukuda, Shinsaku Masamune, Atsushi Ito, Kei Harada, Yoshihiro Yamagata, Taku Koike, Yoshiki Ogata, Yohei Abe, Hiroko Matsuhashi, Tamotsu Takasumi, Mika Hashimoto, Minami Kato, Tsunetaka Hirasawa, Dai Sasaki, Yu Yagi, Makoto Abe, Yasuhiko Horikawa, Yoshinori Satoh, Kennichi Satoh, Itaru Ishihata, Ryoichi Ishiyama, Fumitake Shinkai, Hirohiko Ohyauchi, Motoki Tatsuta, Tetsuya Kikuchi, Hidezumi Chinda, Daisuke Iwai, Wataru Noguchi, Tetsuya Miyazaki, Takefumi Ara, Nobuyuki Ohara, Shuichi Fushiya, Jun Takeda, Hiroaki Shirahata, Nakao Fujishima, Shoichiro Shibukawa, Goro |
| description | Objectives
We aimed to clarify the prognostic factors for patients with esophageal squamous cell carcinoma (ESCC) invading into the muscularis mucosa (pT1a‐MM) or submucosa (pT1b‐SM) after endoscopic submucosal dissection (ESD).
Methods
This retrospective study enrolled such patients at 21 institutions in Japan between 2006 and 2017. We evaluated 15 factors, including pathological risk categories for ESCC‐specific mortality, six non‐cancer‐related indices, and treatment strategies.
Results
In the analysis of 593 patients, the 5‐year overall and disease‐specific survival rates were 83.0% and 97.6%, respectively. In a multivariate Cox analysis, male sex (hazard ratio [HR] 3.56), Charlson comorbidity index (CCI) ≥3 (HR 2.53), ages of 75–79 (HR 1.61) and ≥80 years (HR 2.04), prognostic nutrition index (PNI) |
| doi_str_mv | 10.1111/den.14378 |
| format | Article |
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We aimed to clarify the prognostic factors for patients with esophageal squamous cell carcinoma (ESCC) invading into the muscularis mucosa (pT1a‐MM) or submucosa (pT1b‐SM) after endoscopic submucosal dissection (ESD).
Methods
This retrospective study enrolled such patients at 21 institutions in Japan between 2006 and 2017. We evaluated 15 factors, including pathological risk categories for ESCC‐specific mortality, six non‐cancer‐related indices, and treatment strategies.
Results
In the analysis of 593 patients, the 5‐year overall and disease‐specific survival rates were 83.0% and 97.6%, respectively. In a multivariate Cox analysis, male sex (hazard ratio [HR] 3.56), Charlson comorbidity index (CCI) ≥3 (HR 2.53), ages of 75–79 (HR 1.61) and ≥80 years (HR 2.04), prognostic nutrition index (PNI) <45 (HR 1.69), and pathological intermediate‐risk (HR 1.63) and high‐risk (HR 1.89) were prognostic factors. Subsequently, we developed a clinical risk classification for non‐ESCC‐related mortality based on the number of prognostic factors (age ≥75 years, male sex, CCI ≥3, PNI <45): low‐risk, 0; intermediate‐risk, 1–2; and high‐risk, 3–4. The 5‐year non‐ESCC‐related mortality rates for patients without additional treatment were 0.0%, 10.2%, and 45.8% in the low‐, intermediate‐, and high‐risk groups, respectively. Meanwhile, the 5‐year ESCC‐specific mortality rates for the pathological low‐, intermediate‐, and high‐risk groups were 0.3%, 5.3%, and 18.2%, respectively.
Conclusions
We clarified prognostic factors for patients with pT1a‐MM/pT1b‐SM ESCC after ESD. The combined assessment of non‐ESCC‐ and ESCC‐related mortalities by the two risk classifications might help clinicians in deciding treatment strategies for such patients.</description><identifier>ISSN: 0915-5635</identifier><identifier>EISSN: 1443-1661</identifier><identifier>DOI: 10.1111/den.14378</identifier><identifier>PMID: 35702926</identifier><language>eng</language><publisher>Australia</publisher><subject>Aged ; Aged, 80 and over ; Endoscopic Mucosal Resection ; endoscopic submucosal dissection ; Esophageal Neoplasms - pathology ; esophageal squamous cell carcinoma ; Esophageal Squamous Cell Carcinoma - pathology ; Humans ; Male ; Mucous Membrane - pathology ; Mucous Membrane - surgery ; Prognosis ; prognostic factors ; Retrospective Studies ; Treatment Outcome</subject><ispartof>Digestive endoscopy, 2022-11, Vol.34 (7), p.1382-1391</ispartof><rights>2022 Japan Gastroenterological Endoscopy Society.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3498-676e6b3f5a5d00b6d7c71d5b2f881ab19af846d5ac3035b428a320bab3eecd273</citedby><cites>FETCH-LOGICAL-c3498-676e6b3f5a5d00b6d7c71d5b2f881ab19af846d5ac3035b428a320bab3eecd273</cites><orcidid>0000-0001-9717-0281 ; 0000-0001-6006-1778 ; 0000-0002-9815-1557 ; 0000-0001-8776-6663 ; 0000-0002-0990-9304</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fden.14378$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fden.14378$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35702926$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shimada, Tomohiro</creatorcontrib><creatorcontrib>Hatta, Waku</creatorcontrib><creatorcontrib>Takahashi, So</creatorcontrib><creatorcontrib>Koike, Tomoyuki</creatorcontrib><creatorcontrib>Ohira, Tetsuya</creatorcontrib><creatorcontrib>Hikichi, Takuto</creatorcontrib><creatorcontrib>Toya, Yosuke</creatorcontrib><creatorcontrib>Tanaka, Ippei</creatorcontrib><creatorcontrib>Onozato, Yusuke</creatorcontrib><creatorcontrib>Hamada, Koichi</creatorcontrib><creatorcontrib>Fukushi, Daisuke</creatorcontrib><creatorcontrib>Watanabe, Ko</creatorcontrib><creatorcontrib>Kayaba, Shoichi</creatorcontrib><creatorcontrib>Ito, Hirotaka</creatorcontrib><creatorcontrib>Mikami, Tatsuya</creatorcontrib><creatorcontrib>Oikawa, Tomoyuki</creatorcontrib><creatorcontrib>Takahashi, Yasushi</creatorcontrib><creatorcontrib>Kondo, Yutaka</creatorcontrib><creatorcontrib>Yoshimura, Tetsuro</creatorcontrib><creatorcontrib>Shiroki, Takeharu</creatorcontrib><creatorcontrib>Nagino, Ko</creatorcontrib><creatorcontrib>Hanabata, Norihiro</creatorcontrib><creatorcontrib>Funakubo, Akira</creatorcontrib><creatorcontrib>Nakamura, Jun</creatorcontrib><creatorcontrib>Matsumoto, Takayuki</creatorcontrib><creatorcontrib>Iijima, Katsunori</creatorcontrib><creatorcontrib>Fukuda, Shinsaku</creatorcontrib><creatorcontrib>Masamune, Atsushi</creatorcontrib><creatorcontrib>Ito, Kei</creatorcontrib><creatorcontrib>Harada, Yoshihiro</creatorcontrib><creatorcontrib>Yamagata, Taku</creatorcontrib><creatorcontrib>Koike, Yoshiki</creatorcontrib><creatorcontrib>Ogata, Yohei</creatorcontrib><creatorcontrib>Abe, Hiroko</creatorcontrib><creatorcontrib>Matsuhashi, Tamotsu</creatorcontrib><creatorcontrib>Takasumi, Mika</creatorcontrib><creatorcontrib>Hashimoto, Minami</creatorcontrib><creatorcontrib>Kato, Tsunetaka</creatorcontrib><creatorcontrib>Hirasawa, Dai</creatorcontrib><creatorcontrib>Sasaki, Yu</creatorcontrib><creatorcontrib>Yagi, Makoto</creatorcontrib><creatorcontrib>Abe, Yasuhiko</creatorcontrib><creatorcontrib>Horikawa, Yoshinori</creatorcontrib><creatorcontrib>Satoh, Kennichi</creatorcontrib><creatorcontrib>Satoh, Itaru</creatorcontrib><creatorcontrib>Ishihata, Ryoichi</creatorcontrib><creatorcontrib>Ishiyama, Fumitake</creatorcontrib><creatorcontrib>Shinkai, Hirohiko</creatorcontrib><creatorcontrib>Ohyauchi, Motoki</creatorcontrib><creatorcontrib>Tatsuta, Tetsuya</creatorcontrib><creatorcontrib>Kikuchi, Hidezumi</creatorcontrib><creatorcontrib>Chinda, Daisuke</creatorcontrib><creatorcontrib>Iwai, Wataru</creatorcontrib><creatorcontrib>Noguchi, Tetsuya</creatorcontrib><creatorcontrib>Miyazaki, Takefumi</creatorcontrib><creatorcontrib>Ara, Nobuyuki</creatorcontrib><creatorcontrib>Ohara, Shuichi</creatorcontrib><creatorcontrib>Fushiya, Jun</creatorcontrib><creatorcontrib>Takeda, Hiroaki</creatorcontrib><creatorcontrib>Shirahata, Nakao</creatorcontrib><creatorcontrib>Fujishima, Shoichiro</creatorcontrib><creatorcontrib>Shibukawa, Goro</creatorcontrib><creatorcontrib>Tohoku GI Endoscopy Group</creatorcontrib><title>Combined assessment of clinical and pathological prognostic factors for deciding treatment strategies for esophageal squamous cell carcinoma invading into the muscularis mucosa or submucosa after endoscopic submucosal dissection</title><title>Digestive endoscopy</title><addtitle>Dig Endosc</addtitle><description>Objectives
We aimed to clarify the prognostic factors for patients with esophageal squamous cell carcinoma (ESCC) invading into the muscularis mucosa (pT1a‐MM) or submucosa (pT1b‐SM) after endoscopic submucosal dissection (ESD).
Methods
This retrospective study enrolled such patients at 21 institutions in Japan between 2006 and 2017. We evaluated 15 factors, including pathological risk categories for ESCC‐specific mortality, six non‐cancer‐related indices, and treatment strategies.
Results
In the analysis of 593 patients, the 5‐year overall and disease‐specific survival rates were 83.0% and 97.6%, respectively. In a multivariate Cox analysis, male sex (hazard ratio [HR] 3.56), Charlson comorbidity index (CCI) ≥3 (HR 2.53), ages of 75–79 (HR 1.61) and ≥80 years (HR 2.04), prognostic nutrition index (PNI) <45 (HR 1.69), and pathological intermediate‐risk (HR 1.63) and high‐risk (HR 1.89) were prognostic factors. Subsequently, we developed a clinical risk classification for non‐ESCC‐related mortality based on the number of prognostic factors (age ≥75 years, male sex, CCI ≥3, PNI <45): low‐risk, 0; intermediate‐risk, 1–2; and high‐risk, 3–4. The 5‐year non‐ESCC‐related mortality rates for patients without additional treatment were 0.0%, 10.2%, and 45.8% in the low‐, intermediate‐, and high‐risk groups, respectively. Meanwhile, the 5‐year ESCC‐specific mortality rates for the pathological low‐, intermediate‐, and high‐risk groups were 0.3%, 5.3%, and 18.2%, respectively.
Conclusions
We clarified prognostic factors for patients with pT1a‐MM/pT1b‐SM ESCC after ESD. The combined assessment of non‐ESCC‐ and ESCC‐related mortalities by the two risk classifications might help clinicians in deciding treatment strategies for such patients.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Endoscopic Mucosal Resection</subject><subject>endoscopic submucosal dissection</subject><subject>Esophageal Neoplasms - pathology</subject><subject>esophageal squamous cell carcinoma</subject><subject>Esophageal Squamous Cell Carcinoma - pathology</subject><subject>Humans</subject><subject>Male</subject><subject>Mucous Membrane - pathology</subject><subject>Mucous Membrane - surgery</subject><subject>Prognosis</subject><subject>prognostic factors</subject><subject>Retrospective Studies</subject><subject>Treatment 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Takuto</creator><creator>Toya, Yosuke</creator><creator>Tanaka, Ippei</creator><creator>Onozato, Yusuke</creator><creator>Hamada, Koichi</creator><creator>Fukushi, Daisuke</creator><creator>Watanabe, Ko</creator><creator>Kayaba, Shoichi</creator><creator>Ito, Hirotaka</creator><creator>Mikami, Tatsuya</creator><creator>Oikawa, Tomoyuki</creator><creator>Takahashi, Yasushi</creator><creator>Kondo, Yutaka</creator><creator>Yoshimura, Tetsuro</creator><creator>Shiroki, Takeharu</creator><creator>Nagino, Ko</creator><creator>Hanabata, Norihiro</creator><creator>Funakubo, Akira</creator><creator>Nakamura, Jun</creator><creator>Matsumoto, Takayuki</creator><creator>Iijima, Katsunori</creator><creator>Fukuda, Shinsaku</creator><creator>Masamune, Atsushi</creator><creator>Ito, Kei</creator><creator>Harada, Yoshihiro</creator><creator>Yamagata, Taku</creator><creator>Koike, Yoshiki</creator><creator>Ogata, Yohei</creator><creator>Abe, Hiroko</creator><creator>Matsuhashi, 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Mikami, Tatsuya ; Oikawa, Tomoyuki ; Takahashi, Yasushi ; Kondo, Yutaka ; Yoshimura, Tetsuro ; Shiroki, Takeharu ; Nagino, Ko ; Hanabata, Norihiro ; Funakubo, Akira ; Nakamura, Jun ; Matsumoto, Takayuki ; Iijima, Katsunori ; Fukuda, Shinsaku ; Masamune, Atsushi ; Ito, Kei ; Harada, Yoshihiro ; Yamagata, Taku ; Koike, Yoshiki ; Ogata, Yohei ; Abe, Hiroko ; Matsuhashi, Tamotsu ; Takasumi, Mika ; Hashimoto, Minami ; Kato, Tsunetaka ; Hirasawa, Dai ; Sasaki, Yu ; Yagi, Makoto ; Abe, Yasuhiko ; Horikawa, Yoshinori ; Satoh, Kennichi ; Satoh, Itaru ; Ishihata, Ryoichi ; Ishiyama, Fumitake ; Shinkai, Hirohiko ; Ohyauchi, Motoki ; Tatsuta, Tetsuya ; Kikuchi, Hidezumi ; Chinda, Daisuke ; Iwai, Wataru ; Noguchi, Tetsuya ; Miyazaki, Takefumi ; Ara, Nobuyuki ; Ohara, Shuichi ; Fushiya, Jun ; Takeda, Hiroaki ; Shirahata, Nakao ; Fujishima, Shoichiro ; Shibukawa, Goro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3498-676e6b3f5a5d00b6d7c71d5b2f881ab19af846d5ac3035b428a320bab3eecd273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Endoscopic Mucosal Resection</topic><topic>endoscopic submucosal dissection</topic><topic>Esophageal Neoplasms - pathology</topic><topic>esophageal squamous cell carcinoma</topic><topic>Esophageal Squamous Cell Carcinoma - pathology</topic><topic>Humans</topic><topic>Male</topic><topic>Mucous Membrane - pathology</topic><topic>Mucous Membrane - surgery</topic><topic>Prognosis</topic><topic>prognostic factors</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shimada, Tomohiro</creatorcontrib><creatorcontrib>Hatta, Waku</creatorcontrib><creatorcontrib>Takahashi, So</creatorcontrib><creatorcontrib>Koike, Tomoyuki</creatorcontrib><creatorcontrib>Ohira, Tetsuya</creatorcontrib><creatorcontrib>Hikichi, Takuto</creatorcontrib><creatorcontrib>Toya, Yosuke</creatorcontrib><creatorcontrib>Tanaka, Ippei</creatorcontrib><creatorcontrib>Onozato, Yusuke</creatorcontrib><creatorcontrib>Hamada, Koichi</creatorcontrib><creatorcontrib>Fukushi, Daisuke</creatorcontrib><creatorcontrib>Watanabe, Ko</creatorcontrib><creatorcontrib>Kayaba, Shoichi</creatorcontrib><creatorcontrib>Ito, Hirotaka</creatorcontrib><creatorcontrib>Mikami, Tatsuya</creatorcontrib><creatorcontrib>Oikawa, Tomoyuki</creatorcontrib><creatorcontrib>Takahashi, Yasushi</creatorcontrib><creatorcontrib>Kondo, Yutaka</creatorcontrib><creatorcontrib>Yoshimura, Tetsuro</creatorcontrib><creatorcontrib>Shiroki, Takeharu</creatorcontrib><creatorcontrib>Nagino, Ko</creatorcontrib><creatorcontrib>Hanabata, Norihiro</creatorcontrib><creatorcontrib>Funakubo, Akira</creatorcontrib><creatorcontrib>Nakamura, Jun</creatorcontrib><creatorcontrib>Matsumoto, Takayuki</creatorcontrib><creatorcontrib>Iijima, Katsunori</creatorcontrib><creatorcontrib>Fukuda, Shinsaku</creatorcontrib><creatorcontrib>Masamune, Atsushi</creatorcontrib><creatorcontrib>Ito, Kei</creatorcontrib><creatorcontrib>Harada, Yoshihiro</creatorcontrib><creatorcontrib>Yamagata, Taku</creatorcontrib><creatorcontrib>Koike, Yoshiki</creatorcontrib><creatorcontrib>Ogata, Yohei</creatorcontrib><creatorcontrib>Abe, Hiroko</creatorcontrib><creatorcontrib>Matsuhashi, Tamotsu</creatorcontrib><creatorcontrib>Takasumi, Mika</creatorcontrib><creatorcontrib>Hashimoto, Minami</creatorcontrib><creatorcontrib>Kato, Tsunetaka</creatorcontrib><creatorcontrib>Hirasawa, Dai</creatorcontrib><creatorcontrib>Sasaki, Yu</creatorcontrib><creatorcontrib>Yagi, Makoto</creatorcontrib><creatorcontrib>Abe, Yasuhiko</creatorcontrib><creatorcontrib>Horikawa, Yoshinori</creatorcontrib><creatorcontrib>Satoh, Kennichi</creatorcontrib><creatorcontrib>Satoh, Itaru</creatorcontrib><creatorcontrib>Ishihata, Ryoichi</creatorcontrib><creatorcontrib>Ishiyama, Fumitake</creatorcontrib><creatorcontrib>Shinkai, Hirohiko</creatorcontrib><creatorcontrib>Ohyauchi, Motoki</creatorcontrib><creatorcontrib>Tatsuta, Tetsuya</creatorcontrib><creatorcontrib>Kikuchi, Hidezumi</creatorcontrib><creatorcontrib>Chinda, Daisuke</creatorcontrib><creatorcontrib>Iwai, Wataru</creatorcontrib><creatorcontrib>Noguchi, Tetsuya</creatorcontrib><creatorcontrib>Miyazaki, Takefumi</creatorcontrib><creatorcontrib>Ara, Nobuyuki</creatorcontrib><creatorcontrib>Ohara, Shuichi</creatorcontrib><creatorcontrib>Fushiya, Jun</creatorcontrib><creatorcontrib>Takeda, Hiroaki</creatorcontrib><creatorcontrib>Shirahata, Nakao</creatorcontrib><creatorcontrib>Fujishima, Shoichiro</creatorcontrib><creatorcontrib>Shibukawa, Goro</creatorcontrib><creatorcontrib>Tohoku GI Endoscopy Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Digestive endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shimada, Tomohiro</au><au>Hatta, Waku</au><au>Takahashi, So</au><au>Koike, Tomoyuki</au><au>Ohira, Tetsuya</au><au>Hikichi, Takuto</au><au>Toya, Yosuke</au><au>Tanaka, Ippei</au><au>Onozato, Yusuke</au><au>Hamada, Koichi</au><au>Fukushi, Daisuke</au><au>Watanabe, Ko</au><au>Kayaba, Shoichi</au><au>Ito, Hirotaka</au><au>Mikami, Tatsuya</au><au>Oikawa, Tomoyuki</au><au>Takahashi, Yasushi</au><au>Kondo, Yutaka</au><au>Yoshimura, Tetsuro</au><au>Shiroki, Takeharu</au><au>Nagino, Ko</au><au>Hanabata, Norihiro</au><au>Funakubo, Akira</au><au>Nakamura, Jun</au><au>Matsumoto, Takayuki</au><au>Iijima, Katsunori</au><au>Fukuda, Shinsaku</au><au>Masamune, Atsushi</au><au>Ito, Kei</au><au>Harada, Yoshihiro</au><au>Yamagata, Taku</au><au>Koike, Yoshiki</au><au>Ogata, Yohei</au><au>Abe, Hiroko</au><au>Matsuhashi, Tamotsu</au><au>Takasumi, Mika</au><au>Hashimoto, Minami</au><au>Kato, Tsunetaka</au><au>Hirasawa, Dai</au><au>Sasaki, Yu</au><au>Yagi, Makoto</au><au>Abe, Yasuhiko</au><au>Horikawa, Yoshinori</au><au>Satoh, Kennichi</au><au>Satoh, Itaru</au><au>Ishihata, Ryoichi</au><au>Ishiyama, Fumitake</au><au>Shinkai, Hirohiko</au><au>Ohyauchi, Motoki</au><au>Tatsuta, Tetsuya</au><au>Kikuchi, Hidezumi</au><au>Chinda, Daisuke</au><au>Iwai, Wataru</au><au>Noguchi, Tetsuya</au><au>Miyazaki, Takefumi</au><au>Ara, Nobuyuki</au><au>Ohara, Shuichi</au><au>Fushiya, Jun</au><au>Takeda, Hiroaki</au><au>Shirahata, Nakao</au><au>Fujishima, Shoichiro</au><au>Shibukawa, Goro</au><aucorp>Tohoku GI Endoscopy Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Combined assessment of clinical and pathological prognostic factors for deciding treatment strategies for esophageal squamous cell carcinoma invading into the muscularis mucosa or submucosa after endoscopic submucosal dissection</atitle><jtitle>Digestive endoscopy</jtitle><addtitle>Dig Endosc</addtitle><date>2022-11</date><risdate>2022</risdate><volume>34</volume><issue>7</issue><spage>1382</spage><epage>1391</epage><pages>1382-1391</pages><issn>0915-5635</issn><eissn>1443-1661</eissn><abstract>Objectives
We aimed to clarify the prognostic factors for patients with esophageal squamous cell carcinoma (ESCC) invading into the muscularis mucosa (pT1a‐MM) or submucosa (pT1b‐SM) after endoscopic submucosal dissection (ESD).
Methods
This retrospective study enrolled such patients at 21 institutions in Japan between 2006 and 2017. We evaluated 15 factors, including pathological risk categories for ESCC‐specific mortality, six non‐cancer‐related indices, and treatment strategies.
Results
In the analysis of 593 patients, the 5‐year overall and disease‐specific survival rates were 83.0% and 97.6%, respectively. In a multivariate Cox analysis, male sex (hazard ratio [HR] 3.56), Charlson comorbidity index (CCI) ≥3 (HR 2.53), ages of 75–79 (HR 1.61) and ≥80 years (HR 2.04), prognostic nutrition index (PNI) <45 (HR 1.69), and pathological intermediate‐risk (HR 1.63) and high‐risk (HR 1.89) were prognostic factors. Subsequently, we developed a clinical risk classification for non‐ESCC‐related mortality based on the number of prognostic factors (age ≥75 years, male sex, CCI ≥3, PNI <45): low‐risk, 0; intermediate‐risk, 1–2; and high‐risk, 3–4. The 5‐year non‐ESCC‐related mortality rates for patients without additional treatment were 0.0%, 10.2%, and 45.8% in the low‐, intermediate‐, and high‐risk groups, respectively. Meanwhile, the 5‐year ESCC‐specific mortality rates for the pathological low‐, intermediate‐, and high‐risk groups were 0.3%, 5.3%, and 18.2%, respectively.
Conclusions
We clarified prognostic factors for patients with pT1a‐MM/pT1b‐SM ESCC after ESD. The combined assessment of non‐ESCC‐ and ESCC‐related mortalities by the two risk classifications might help clinicians in deciding treatment strategies for such patients.</abstract><cop>Australia</cop><pmid>35702926</pmid><doi>10.1111/den.14378</doi><tpages>1391</tpages><orcidid>https://orcid.org/0000-0001-9717-0281</orcidid><orcidid>https://orcid.org/0000-0001-6006-1778</orcidid><orcidid>https://orcid.org/0000-0002-9815-1557</orcidid><orcidid>https://orcid.org/0000-0001-8776-6663</orcidid><orcidid>https://orcid.org/0000-0002-0990-9304</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0915-5635 |
| ispartof | Digestive endoscopy, 2022-11, Vol.34 (7), p.1382-1391 |
| issn | 0915-5635 1443-1661 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2676922095 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Aged Aged, 80 and over Endoscopic Mucosal Resection endoscopic submucosal dissection Esophageal Neoplasms - pathology esophageal squamous cell carcinoma Esophageal Squamous Cell Carcinoma - pathology Humans Male Mucous Membrane - pathology Mucous Membrane - surgery Prognosis prognostic factors Retrospective Studies Treatment Outcome |
| title | Combined assessment of clinical and pathological prognostic factors for deciding treatment strategies for esophageal squamous cell carcinoma invading into the muscularis mucosa or submucosa after endoscopic submucosal dissection |
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