Premium
Salvage endoscopic resection ( ER ) after chemoradiotherapy for esophageal squamous cell carcinoma: What are the risk factors for recurrence after salvage ER ?
Author(s) -
Hombu Takuya,
Yano Tomonori,
Hatogai Ken,
Kojima Takashi,
Kadota Tomohiro,
Onozawa Masakatsu,
Yoda Yusuke,
Hori Keisuke,
Oono Yasuhiro,
Ikematsu Hiroaki,
Fujii Satoshi
Publication year - 2018
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12984
Subject(s) - medicine , salvage therapy , chemoradiotherapy , esophageal squamous cell carcinoma , confidence interval , multivariate analysis , surgery , carcinoma , overall survival , chemotherapy
Background and Aim Salvage endoscopic resection ( ER ) is among the curative treatments for superficial local failure after chemoradiotherapy ( CRT ) for esophageal squamous cell carcinoma ( ESCC ). The present study aimed to clarify risk factors for recurrence after salvage ER . Methods This study enrolled consecutive ESCC patients treated with salvage ER for local failure after CRT between 1998 and 2013. Recurrences after salvage ER included locoregional recurrences and distant metastases. Multivariate analysis was carried out on clinicopathological parameters to identify risk factors for post‐salvage ER recurrence. Results Of the 72 patients enrolled in this study, 37/8/23/4 patients had been staged before CRT as cT 1/T2/T3/T4 and 44/28 patients as cN 0/N1, respectively, and local failures detected before salvage ER were residual lesions after CRT in 19 and local recurrences in 53 patients. Resected specimens were classified as pT 1a (M) in 45 and pT 1b ( SM ) in 27 patients. During the median 45‐month follow up (range, 3–175 months) after salvage ER , 27 (38%) patients developed recurrence with a 3‐year recurrence‐free survival rate of 48.9% (95% confidence interval [ CI ], 36.5–60.3). Multivariate analysis showed that residual lesions after CRT ( HR , 2.55; 95% CI , 1.32–4.94) and lesions with a submucosal tumor ( SMT )‐like appearance before salvage ER ( HR , 2.08; 95% CI , 1.04–4.18) were significantly associated with post‐salvage ER recurrence. Conclusions Clinical findings (e.g. residual tumors found immediately after CRT and macroscopic SMT ‐like appearance before salvage ER ) were shown to be significant risk factors for post‐salvage ER recurrence.