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Metastatic risk after endoscopic resection of superficial esophageal squamous cell carcinoma

The latest issue of the American Journal of Gastroenterology reports on the long-term outcome and metastatic risk after endoscopic resection of superficial esophageal squamous cell carcinoma.

News image

Long-term outcomes after endoscopic resection provide important information for the treatment of esophageal carcinoma.

Dr Takeshi Yamashina and colleagues investigated the rates of survival and metastasis after endoscopic resection of esophageal carcinoma.

The team reported that from 1995 to 2010, 570 patients with esophageal carcinoma were treated by endoscopic resection.

Of these, the 402 patients with squamous cell carcinoma were included in our analysis.

The research team found that 17 patients had cancer invading into the submucosa up to 0.2 mm, and 35 patients had cancer invading into the submucosa more than 0.2 mm.

The mean follow-up time was 50 months.

The 5-year overall survival rates of patients with epithelial/lamina propria, muscularis mucosa , and submucosal cancer were 91%, 71%, and 71%, respectively.

The cumulative 5-year metastasis rates in patients with mucosal cancer were 47%
Am J Gastroenterology

The researchers identified depth of invasion and age as independent predictors of survival, with hazard ratios of 3.6 for muscularis mucosa cancer, and 3.2 for submucosal cancer compared with epithelial /lamina propria cancer, and 1.07 per year of age.

The cumulative 5-year metastasis rates in patients with epithelial/lamina propria, muscularis mucosa, submucosa up to 0.2 mm, and submucosa more than 0.2 mm cancer were 0.4%, 9%, 8%, and 36%, respectively. 

The research team found that identified depth of invasion as an independent risk factor for metastasis, with hazard ratios of 13 for muscularis mucosa , 40 for submucosa up to 0.2 mm, and 196 for submucosa more than 0.2 mm cancer compared with epithelial /lamina propria cancer.

The cumulative 5-year metastasis rates in patients with mucosal cancer with and without lymphovascular involvement were 47%, and 0.7%, respectively.

Dr Yamashina's team concludes, "The long-term risk of metastasis after endoscopic resection was mainly associated with the depth of invasion."

"This risk should be taken into account when considering the indications for endoscopic resection."

Am J Gastroenterol 2013; 108:544551
23 April 2013

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