Clinical features of early esophageal neoplastic lesions at different stages and efficacy and prognosis after endoscopic submucosal dissection

doi:10.3748/wjg.v31.i38.110557

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Oct 14, 2025; 31(38): 110557
Published online Oct 14, 2025. doi: 10.3748/wjg.v31.i38.110557

Table 1 Clinical and endoscopic features of differentially differentiated esophageal mucosal tumors, n (%)

	LGIN (n = 71)	HGIN (n = 97)	Early cancer (n = 65)	Superficial cancer (n = 31)	P value
Gender					0.818
Male	53 (74.6)	71 (73.2)	44 (67.7)	22 (71.0)
Female	18 (25.4)	26 (26.8)	21 (32.3)	9 (29.0)
Age (years)	61.34 ± 6.94	62.8 ± 8.10	62.91 ± 7.66	61.84 ± 9.06	0.578
Comorbidities
Diabetes	8 (11.3)	10 (10.3)	6 (9.2)	1 (3.2)	0.676
Hypertension	20 (28.2)	24 (24.7)	20 (30.8)	6 (19.4)	0.642
Cardiovascular disease	10 (14.1)	14 (14.4)	7 (10.8)	3 (9.7)	0.873
Liver cirrhosis	8 (11.3)	3 (3.1)	5 (7.7)	1 (3.2)	0.167
Respiratory diseases	7 (9.9)	13 (13.4)	6 (9.2)	8 (25.8)	0.141
Gastroesophageal reflux disease	38 (31.7)	46 (38.3)	26 (40.0)	10 (32.3)	0.174
Barrett's esophagus	3 (4.2)	3 (3.1)	4 (6.2)	0 (0)	0.575
Atrophic gastritis	49 (69.0)	64 (66.0)	43 (66.2)	23 (74.2)	0.836
Hiatal hernia	5 (7.0)	2 (2.1)	2 (3.1)	0 (0)	0.315
Previous tumor history	7 (9.9)	12 (12.4)	8 (12.3)	4 (12.9)	0.943
Previous esophageal cancer history	1 (1.4)	3 (3.1)	0 (0)	2 (6.5)	0.195
Smoking history	28 (39.4)	48 (49.5)	31 (47.7)	19 (61.3)	0.225
Alcohol history	22 (31.0)	32 (33.0)	13 (20.0)	13 (41.9)	0.133
Family history	17 (23.9)	12 (12.4)	5 (7.7)	5 (16.1)	0.055
Accompanying symptoms
Dysphagia	9 (12.7)	13 (13.4)	9 (13.8)	8 (25.8)	0.392
Retrosternal pain	16 (22.5)	26 (26.8)	10 (15.4)	9 (29.0)	0.314
Weight loss	10 (14.1)	12 (12.4)	8 (12.3)	2 (6.5)	0.716
Other	40 (56.3)	51 (52.6)	41 (63.1)	13 (41.9)	0.248
White light endoscopic
Redness	48 (67.6)	72 (74.2)	48 (73.8)	21 (67.7)	0.735
Whitening	11 (15.5)	16 (16.5)	9 (13.8)	4 (12.9)	0.973
Roughness	52 (73.2)	82 (84.5)	47 (72.3)	25 (80.6)	0.194
Erosion	6 (8.5)^c	16 (16.5)	22 (33.8)^a	5 (16.1)	0.002
Nodule	2 (2.8)	7 (7.2)	10 (15.4)	5 (16.1)	0.024
White coating	7 (9.9)	13 (13.4)	11 (16.9)	3 (9.7)	0.640
Submucosal vascular blurring or loss	1 (1.4)^b^,^c	18 (18.6)^a	9 (13.8)^a	3 (9.7)	0.002

^aP < 0.05 vs low-grade intraepithelial neoplasia.

^bP < 0.05 vs high-grade intraepithelial neoplasia.

^cP < 0.05 vs early cancer.

LGIN: Low-grade intraepithelial neoplasia; HGIN: High-grade intraepithelial neoplasia.

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Table 2 Narrow-band spectral imaging performance of esophageal mucosal tumors of varying differentiation using magnifying endoscopy, n (%)

	LGIN (n = 64, 25.9%)	HGIN (n = 92, 37.3%)	Early cancer (n = 61, 24.6%)	Superficial cancer (n = 30, 12.2%)	P value
IPCL
A	21 (29.6)^b^,^c^,^d	9 (9.3)^a	2 (3.1)^a	0 (0)^a	< 0.001
B1	40 (56.3)	64 (66.0)	30 (46.2)	15 (48.4)	0.066
B2	3 (4.2)^b^,^c^,^d	18 (18.6)^a^,^c^,^d	29 (44.6)^a^,^b	14 (45.2)^a^,^b	< 0.001
B3	0 (0)	1 (1.0)	0 (0)	1 (3.2)	0.353

^aP < 0.05 vs low-grade intraepithelial neoplasia.

^bP < 0.05 vs high-grade intraepithelial neoplasia.

^cP < 0.05 vs early cancer.

^dP < 0.05 vs superficial cancer.

LGIN: Low-grade intraepithelial neoplasia; HGIN: High-grade intraepithelial neoplasia; IPCL: Intra-epithelial papillary capillary loop.

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Table 3 Pathological characteristics of esophageal mucosal tumors with different degrees of differentiation, n (%)

	LGIN (n = 71)	HGIN (n = 97)	Early cancer (n = 65)	Superficial cancer (n = 31)	P value
Lesion location					0.033
Upper 1/3	18 (25.4)^b	9 (9.3)^a	10 (15.4)	2 (6.5)
Middle 1/3	36 (50.7)	48 (49.5)	34 (52.3)	14 (45.2)
Lower 1/3	17 (23.9)	40 (41.2)	21 (32.3)	15 (48.4)
Lesion length (cm)					< 0.001
≤ 2	46 (64.8)^b^,^c^,^d	25 (25.8)^a	12 (18.5)^a	9 (29.0)^a
> 2 and < 5	22 (31.0)^b^,^c	58 (59.8)^a	37 (56.9)^a	14 (45.2)
≥ 5	3 (4.2)^c^,^d	14 (14.4)	16 (24.6)^a	8 (25.8)^a
Circumferential extent					< 0.001
< 1/2	59 (83.1)^b^,^c^,^d	60 (61.9)^a	31 (47.7)^a	17 (54.8)^a
≥ 1/2 and < 3/4	12 (16.9)	27 (27.8)	16 (24.6)	3 (9.7)
≥ 3/4	0 (0)^b^,^c^,^d	10 (10.3)^a^,^c^,^d	18 (27.7)^a^,^b	11 (35.5)^a^,^b
Invasion depth					< 0.001
M1	71 (100)^c^,^d	97 (100)^c^,^d	0 (0)^a^,^b	0 (0)^a^,^b
M2	0 (0)^c	0 (0)^c	36 (55.4)^a^,^b^,^d	1 (3.2)^c
M3	0 (0)^c^,^d	0 (0)^c^,^d	29 (44.6)^a^,^b^,^d	5 (16.1)^a^,^b^,^c
SM1	0 (0)^d	0 (0)^d	0 (0)^d	23 (74.2)^a^,^b^,^c
SM2	0 (0)	0 (0)	0 (0)	2 (6.5)
Vertical margin					< 0.001
Positive	0 (0)^d	0 (0)^d	4 (6.2)	5 (16.1)^a^,^b
Negative	71 (100)^d	97 (100) ^d	61 (93.8)	26 (83.9)^a^,^b
Horizontal margin					0.001
Positive	0 (0)^d	5 (5.2)	6 (9.2)	6 (19.4)^a
Negative	71 (100)^d	92 (94.8)	59 (90.8)	25 (80.6)^a
Lymphatic invasion					0.364
Positive	0 (0)	0 (0)	1 (1.5)	0 (0)
Negative	71 (100)	97 (100)	64 (98.5)	31 (100)
Vascular invasion					< 0.001
Positive	0 (0)^d	0 (0)^d	0 (0)^d	8 (25.8)^a^,^b^,^c
Negative	71 (100)^d	97 (100)^d	65 (100)^d	23 (74.2)^a^,^b^,^c
Multiple lesions	17 (23.9)^b	7 (7.2)^a	8 (12.3)	6 (19.4)	0.015
Paris classification					0.001
0-I	3 (4.2)	0 (0)	1 (1.5)	0 (0)
0-IIa	4 (5.6)	11 (11.3)	10 (15.4 )	3 (9.7)
0-IIb	59 (83.1)^c^,^d	74 (76.3)	42 (64.6)^a	18 (58.1)^a
0-IIc	5 (7.0)	9 (9.3)	6 (9.2)	3 (9.7)
Mixed type	0 (0)^c^,^d	3 (3.1)^d	7 (10.8)^a	7 (22.6)^a^,^b

^aP < 0.05 vs low-grade intraepithelial neoplasia.

^bP < 0.05 vs high-grade intraepithelial neoplasia.

^cP < 0.05 vs early cancer.

^dP < 0.05 vs superficial cancer.

0-I: Superficial and protruding; 0-IIa: Slightly elevated; 0-IIb: Flat; 0-IIc: Slightly depressed; 0-II: Superficial and excavated (type 0-III); Mixed type: In lesions with combined morphology (e.g., 0-IIa + 0-IIc); M1: Tumor limited to the mucosal epithelium; M2: Tumor limited to the lamina propria without involvement of the muscular mucosa; M3: Tumor involving the muscularis mucosa; SM1: Tumor infiltrated into the superficial submucosa (from the muscularis mucosa to the submucosa < 200 μm); SM2: Tumor involved the deep submucosa (≥ 200 μm in submucosa); LGIN: Low-grade intraepithelial neoplasia; HGIN: High-grade intraepithelial neoplasia.

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Table 4 Efficacy and safety of endoscopic mucosal dissection in esophageal tumors of varying differentiation, n (%)

	LGIN (n = 71, 26.9%)	HGIN (n = 97, 36.7%)	Early cancer (n = 65, 24.6%)	Superficial cancer (n = 31, 11.7%)	P value
Short-term outcomes
Absolute indication	71 (100)^b^,^c^,^d	88 (90.7)^a^,^c^,^d	26 (40.0)^a^,^b^,^d	0 (0)^a^,^b^,^c	< 0.001
R0 resection	71 (100)^c^,^d	92 (94.8)^d	56 (86.2)^a	22 (71.0)^a^,^b	< 0.001
CR	71 (100)^c^,^d	92 (94.8)^d	55 (84.6)^a^,^d	16 (51.6)^a^,^b^,^c	< 0.001
Muscle layer injury	3 (4.2)^d	13 (13.4)	8 (12.3)	9 (29.0)^a	0.008
Complications	4 (5.6)^c^,^d	17 (17.5)	16 (24.6)^a	12 (38.7)^a	< 0.001
Bleeding	0 (0)	3 (3.1)	0 (0)	0 (0)	0.363
Perforation	1 (0)	0 (0)	0 (0)	1 (3.2)	0.198
Stricture	3 (4.2)^c^,^d	14 (14.4)	16 (24.6)^a	11 (35.5)^a	< 0.001
Long-term outcomes
BMI (kg/m²)	24.22 (22.76-25.60)^b^,^c^,^d	23.04 (20.95-24.95)^a	23.53 (20.57-24.73)^a	21.97 (18.94-23.00)^a	< 0.001
Adverse outcomes	1 (2.8)^c^,^d	6 (6.2)^d	8 (12.3)^a	6 (19.4)^a^,^b	0.006
Recurrence	0 (0)^c^,^d	3 (3.1)^d	4 (6.2)^a	4 (12.9)^a^,^b	0.014
Metastasis	0 (0)	1 (1.0)	1 (1.5)	0 (0)	0.802
Mortality	1 (1.4)	2 (2.1)	5 (7.7)	2 (6.5)	0.133
Multiple primary cancers	11 (15.5)	13 (13.4)	11 (16.9)	5 (16.1)	0.933

^aP < 0.05 vs low-grade intraepithelial neoplasia.

^bP < 0.05 vs high-grade intraepithelial neoplasia.

^cP < 0.05 vs early cancer.

^dP < 0.05 vs superficial cancer.

LGIN: Low-grade intraepithelial neoplasia; HGIN: High-grade intraepithelial neoplasia; CR: Curative resection; BMI: Body mass index.

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Table 5 Multifactorial analysis of factors associated with curative vs complete resection

Variable	Category	P value	Odds ratio	95%CI
CR
Differentiation degree	HGIN	< 0.001	11.460	3.404-38.582
	Early cancer	0.014	3.722	1.312-10.564
	Superficial cancer		1
Retrosternal pain	No		1
Retrosternal pain	Yes	0.036	0.340	0.124-0.931
BMI		0.032	1.205	1.016-1.430
R0 resection
Differentiation degree	HGIN	< 0.001	7.527	2.294-24.695
	Early cancer	0.080	2.545	0.893-7.255
	Superficial cancer		1

HGIN: High-grade intraepithelial neoplasia; CR: Curative resection; BMI: Body mass index.

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Table 6 Multifactorial analysis of complications and factors associated with esophageal stricture

Variable	Category	P value	Odds ratio	95%CI
Complications
Gender	Male		1
Gender	Female	0.009^a	2.320	0.838-6.423
BMI	-	0.008^a	0.837	0.734-0.956
Lesion length (cm)	≤ 2		1
Lesion length (cm)	≥ 5	0.021^a	4.411	1.251-15.548
Circumferential extent	< 1/2		1
Circumferential extent	≥ 3/4	< 0.001^a	5.820	2.180-15.537
R0 resection	No		1
R0 resection	Yes	0.023^a	0.288	0.098-0.841
Esophageal stenosis
Gender	Male		1
Gender	Female	0.032^a	2.450	1.078-5.571
Lesion length (cm)	≤ 2		1
Lesion length (cm)	≥ 5	0.026^a	5.833	1.232-27.626
Circumferential extent	< 1/2		1
Circumferential extent	≥ 3/4	0.033^a	3.472	1.104-10.922
Stenosis prevention	No		1
Stenosis prevention	Yes	0.006^a	4.161	1.490-11.615

^aP < 0.05.

BMI: Body mass index.

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Table 7 Cox regression multifactorial analysis of factors associated with time to recurrence, metastasis, death, and recurrence metastasis

Variable	Category	P value	Hazard ratio	95%CI
Recurrence, metastasis, death survival
Age	-	0.031^a	1.018	1.002-1.034
Prior esophageal cancer	No		1
Prior esophageal cancer	Yes	0.029^a	3.050	1.120-8.303
Recurrence metastasis survival
Prior esophageal cancer	No		1
Prior esophageal cancer	Yes	0.001^a	18.230	3.064-108.461
Depth of invasion	M1		1
Depth of invasion	SM2	0.003^a	30.213	3.207-284.650

^aP < 0.05.

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Table 8 Comparison of Cox regression results before and after excluding superficial cancer cases

Variable	Model type	Hazard ratio (95%CI)	P value
Age	Full model	1.018 (1.002–1.034)	0.031^a
Age	Sensitivity model	1.097 (1.032–1.165)	0.003^a
Prior esophageal cancer	Full model	3.050 (1.120-8.303)	0.029^a
Prior esophageal cancer	Sensitivity model	10.429 (1.227-88.634)	0.032^a

^aP < 0.05.

Sensitivity model excludes superficial cancer cases (n = 31). Cox regression models were adjusted for age and prior cancer history. Results remained robust.

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Citation: Zhang YM, Zhu N, Chen MY, Li FL, Qin B, Jiang J, Wang SH, Wu J, Quan XJ, Wang CY, Zheng Y, Zou BC. Clinical features of early esophageal neoplastic lesions at different stages and efficacy and prognosis after endoscopic submucosal dissection. World J Gastroenterol 2025; 31(38): 110557
URL: https://www.wjgnet.com/1007-9327/full/v31/i38/110557.htm
DOI: https://dx.doi.org/10.3748/wjg.v31.i38.110557