The Overall Prevalence of Metastasis in T1 Esophageal Squamous Cell Carcinoma

Akutsu, Yasunori; Uesato, Masaya; Shuto, Kiyohiko; Kono, Toru; Hoshino, Isamu; Horibe, Daisuke; Sazuka, Testutaro; Takeshita, Nobuyoshi; Maruyama, Tetsuro; Isozaki, Yuka; Akanuma, Naoki; Matsubara, Hisahiro

doi:10.1097/sla.0b013e31827017fc

Cited by 146 publications

(142 citation statements)

References 34 publications

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“…Among 11 patients with additional CRT, three relapses (27%) were observed. These results were similar to the rate of the previous reports of 25-50% (6,13). Therefore, preceding ESD contributed to the reduction of the radiation dose and fields and prevented RT-related toxicities without increasing the relapse rate.…”

Section: Discussionsupporting

confidence: 81%

“…Akutsu et al observed that when the tumor depth was ! SM 2, the patient had both a higher rate of lymph node involvement and also hematological recurrences, such as liver or lung metastases (13). Furthermore, their univariate and multivariate analyses showed that the tumor depth and presence of lymphatic and venous invasion were identified to be independent risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study revealed the correlation between the rate of lymph node metastasis and the depth of the tumor invasion of superficial esophageal cancers. The rate of lymph node metastasis of the lesions infiltrated into the upper one-third of the submucosa (SM1), the middle one-third (SM2), and the bottom one-third (SM3) were 27%, 36%, and 55%, respectively (13).…”

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confidence: 99%

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Endoscopic Submucosal Dissection (ESD) with Additional Therapy for Superficial Esophageal Cancer with Submucosal Invasion

et al. 2015

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Objective The standard treatment for submucosal esophageal cancer is esophagectomy or chemoradiotherapy (CRT). However, these treatment modalities could deteriorate the general condition and quality of life of the patients who are intolerant to invasive therapy. It is therefore important and beneficial to develop less invasive treatment protocols for these patients. Methods The study included 43 patients who were clinically suspected of mucosa or submucosal esophageal cancer but underwent endoscopic submucosal dissection (ESD) as a primary treatment, due to the patients' poor performance statuses and/or preferences for less invasive therapy. According to the pathological findings and patient's general condition, whether the patient underwent additional treatments or remained hospitalized without additional treatments was thereafter decided for each patient. We retrospectively analyzed the outcomes of these patients. Results Fifteen patients underwent additional surgery, 11 patients underwent CRT/radiation therapy (RT) and 17 patients were followed without additional treatments. During the 3-year follow-up period, the relapsefree survival rates in the patients who received or did not receive additional treatments were 88% and 64%, respectively (95% confidence interval, 0.45-0.76, p=0.04). The relapse-free and overall survival rates in the patients with additional treatments were equivalent or superior to those described in previous reports of the standard treatments. Preceding ESD contributed to reduce the local relapse significantly to approximately 3.5% and additional CRT-related toxicities. Conclusion Preceding ESD is very effective for the local control of cancer, and useful for histologically confirming the high-risk factors of relapse, such as ! submucosal layer 2 (SM2) invasion and lymphovascular involvements. ESD with additional therapy may be a promising strategy for optimizing the selection of therapy depending on the patient's general condition.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Endoscopic Submucosal Dissection (ESD) with Additional Therapy for Superficial Esophageal Cancer with Submucosal Invasion

et al. 2015

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“…In the multivariate analysis, in this study, sm3 and tumor location were strongly correlated with a worse overall survival rate. The depth of submucosal infiltration and lymphatic and venous invasion seemed to be an independent risk factor for LN metastases in a retrospective surgical study conducted on 295 patients with T1 esophageal squamocellular carcinoma [6]. A multicenter study that evaluated patients who were initially submitted to endoscopic resection of early esophageal adenocarcinoma (EAC) followed by esophagectomy, demonstrated that 24% of the patients with T1b tumors had positive LN [7].…”

Section: Early Esophageal Lesionsmentioning

confidence: 99%

A Surgeon’s Role in the Management of Early Esophageal, EGJ and Gastric Lesions

Simić

Skrobić

Peško

2019

Dig Dis

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Background: Endoscopic mucosal resection and submucosal dissection (ESD) are indicated in a majority of mucosal esophageal, esophagogastric junction and gastric cancers (GC), and selected cases of submucosal cancers as well. Summary: The presence of lymph node metastases in early esophageal cancer (EC) has been proven in up to 50% of patients with sm3 cancers treated with surgical resection, and up to 18.5 and 30.5% in sm1 and sm2 cancer respectively. The presence of lymphovascular invasion (LVI), tumor depth >500 μm and poor tumor differentiation seem to be a common predictor of worse outcomes in literature reports. In case of early esophagogastric junction cancer (EGJC) these predictors include LVI, tumor size >3 cm, Barrett’s origin of the tumor and ulcerative tumor appearance. Extended indications for ESD in early GC are already adopted in high volume centers with high success rates (up to 98%). Jet, positive resection margins after ESD, LVI and poor tumor differentiation carry high metastatic potential, therefore advocating surgery. Limited resections and cooperative laparoscopic endoscopic approach may be implemented in cases of early EGJC and GC. Key Messages: The presence of LVI, depth of submucosal invasion, and poor tumor differentiation in cases of early EC, EGJC, and GC favor surgical treatment despite improvements in endoscopic techniques.

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“…Endoscopic submucosal dissection is a widely accepted procedure to curative treatment of SESCC limited to the epithelium or lamina propria mucosa (EP/LPM) because LN metastasis is rarely observed in these lesions [2][3][4]. However, LN metastasis is seen in approximately 10% of cases of SESCC with invasion into the muscularis mucosa or mildly into the submucosa (MM/SM1) and in approximately 40% with moderate or deep invasion into the submucosa (SM2/SM3) [5]. Therefore, MM/SM1 and SM2/SM3 SCCS are usually considered indications for surgery, chemoradiotherapy, or both.…”

Section: Introductionmentioning

confidence: 99%

Magnifying Endoscopy with Narrow Band Imaging in Estimating the Invasion Depth of Superficial Esophageal Squamous Cell Carcinomas

Mizumoto¹,

Hiyama

Quach

et al. 2018

Digestion

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Background/Aim: The aim of this study was to compare the accuracy of magnifying endoscopy with narrow band imaging for the diagnosis of depth of invasion by Japan Esophageal Society (JES) classification and inter- and intraobserver agreement of JES intrapapillary capillary loop (IPCL) classification. Methods: It was a retrospective observational study that has analyzed 136 patients with esophageal malignant neoplasia with magnifying endoscopy narrow band imaging to compare JES’s IPCL classification to the histopathologic findings and to evaluate the inter- and intraobserver agreement. Results: Histopathologic examinations revealed 34 (25.7%) intraepithelial neoplasias, 70 (51.5%) squamous cell carcinomas (SCCs) in the epithelium or with invasion into the lamina propria mucosa, 21 (15.4%) SCCs with invasion into the muscularis mucosa or mild invasion into the submucosa, and 11 (8.1%) SCCs with moderate or deep invasion into the submucosa. IPCL types B1, B2, and B3 also showed high accuracies of 80.8, 83.1, and 94.1%, respectively. The kappa values for inter- and intraobserver agreements of the IPCL classifications were moderate to almost perfect. Conclusions: In the present study, the JES’s IPCL classification has good accuracy to predict the depth of SCC invasion and moderate to almost perfect intra- and interobserver agreements.

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The Overall Prevalence of Metastasis in T1 Esophageal Squamous Cell Carcinoma

Abstract: Our study provides a precise assessment of the comprehensive risk of metastasis and feasible predictive markers for T1 ESCC.

Cited by 146 publications

References 34 publications

Endoscopic Submucosal Dissection (ESD) with Additional Therapy for Superficial Esophageal Cancer with Submucosal Invasion

Endoscopic Submucosal Dissection (ESD) with Additional Therapy for Superficial Esophageal Cancer with Submucosal Invasion

A Surgeon’s Role in the Management of Early Esophageal, EGJ and Gastric Lesions

Magnifying Endoscopy with Narrow Band Imaging in Estimating the Invasion Depth of Superficial Esophageal Squamous Cell Carcinomas

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