2250 - Exploring the Value of Additional Treatments Based on the Patterns of Failure After Endoscopic Resection for Superficial Esophageal Squamous Cell Carcinoma
Presenter(s)
S. Chen, Y. Wang, J. Ai, M. Ge, Y. Zhang, S. Zou, S. Yue, Y. Cheng, and J. Wang; Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
Purpose/Objective(s): This study aimed to analyze efficacy of patients with superficial esophageal squamous cell carcinoma (SESCC) after endoscopic resection (ER), and elucidate the recurrence characteristics among subgroups with tumor invasion depths.
Materials/Methods: A retrospective analysis was conducted on the recurrence sites, post-recurrence pathological types, and distant metastasis characteristics of 184 patients with SESCC who underwent ER. The depths of tumor invasion were classified as carcinoma in epithelium/lamina propria mucosae (T1a-EP/LPM) in 105 cases, muscularis mucosae (T1a-MM) in 42 cases, and submucosa (T1b) in 37 cases. Following ER, 2 patients in the T1a-MM stage received additional treatments (1 received radiotherapy, and 1 underwent surgical resection); 16 patients in the T1b stage received additional treatments (6 received chemoradiotherapy, and 10 underwent esophagectomy).
Results: The median follow-up was 64 months. For the entire cohort, the 3- and 5-year PFS rates were 85.5% and 78.4%, respectively, while the 3- and 5-year OS rates were 94.0% and 91.0%, respectively. The 5-year PFS rates for the T1a-EP/LPM, T1a-MM, and T1b groups were 80.1%, 71.3%, and 81.4%, respectively; their corresponding 5-year OS rates were 90.9%, 88.1%, and 94.3%. Recurrence occurred in 40 patients (21.5%). Among these, 20 patients experienced isolated local recurrence in the esophagus (including 1 case with bone metastasis), and 20 patients presented with recurrence at different esophageal sites and/or regional lymph node metastasis. The recurrence rate in the T1a-EP/LPM group was 19.0% (20/105), with esophageal intraepithelial neoplasia predominantly (75.0%, 15/20). The recurrence rate in the T1a-MM group was 33.3% (14/42), primarily presenting as invasive carcinoma (50.0%, 7/14). The recurrence rate in the T1b group was 16.2% (6/37), predominantly presenting as invasive carcinoma (66.7%, 4/6).
Conclusion: Locoregional recurrence serves as the primary pattern of failure in patients with SESCC following ER, and it is closely associated with the depth of tumor invasion. For patients in the T1a-EP/LPM stage, intensive postoperative endoscopic surveillance is paramount. Conversely, for patients in the T1b stage exhibiting higher invasiveness, adjuvant chemoradiotherapy or surgical resection represents a crucial strategy to mitigate the risk of failure. This study highlights that patients in the T1a-MM stage received insufficient additional treatments following ER, leading to a higher risk of recurrence. Postoperative management strategies should be individually tailored based on the depth.