Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2024; 16(2): 72-82
Published online Feb 16, 2024. doi: 10.4253/wjge.v16.i2.72
Comparative efficacy and safety between endoscopic submucosal dissection, surgery and definitive chemoradiotherapy in patients with cT1N0M0 esophageal cancer
Shu-Ai Luo, Yu-Ying Sun, Ya-Ting Zeng, Chun-Yu Huang
Shu-Ai Luo, Yu-Ying Sun, Ya-Ting Zeng, Chun-Yu Huang, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Co-first authors: Shu-Ai Luo and Yu-Ying Sun.
Author contributions: Huang CY designed and performed the research and supervised the report; Luo SA performed the research, collected the data, wrote the paper and contributed to the analysis; Sun YY supervised the report, wrote the paper and revised the paper; Zeng YT contributed to the analysis and provided clinical advice. Luo SA and Sun YY have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper.
Supported by the Guangdong Esophageal Cancer Institute Science and Technology Program, No. M202013; and Guangdong Medical Research Foundation, No. A2021369.
Institutional review board statement: All procedures in studies involving human participants were carried out in accordance with ethical standards and approved by the Ethics Committee (No. SL-B2023-032-01).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. For full disclosure, the details of the study are published on the home page of Sun Yat-sen University Cancer Center.
Conflict-of-interest statement: The authors declare that they have no financial relationships to disclose.
Data sharing statement: The raw data used to support the findings of this study could be obtained by getting in touch with the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chun-Yu Huang, MD, PhD, Professor, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou 510060, Guangdong Province, China. huangchy@sysucc.org.cn
Received: November 22, 2023
Peer-review started: November 22, 2023
First decision: November 30, 2023
Revised: December 19, 2023
Accepted: December 25, 2023
Article in press: December 25, 2023
Published online: February 16, 2024
Processing time: 69 Days and 20.5 Hours
Abstract
BACKGROUND

Endoscopic submucosal dissection (ESD) and surgical resection are the standard of care for cT1N0M0 esophageal cancer (EC), whereas definitive chemoradiotherapy (d-CRT) is a treatment option. Nevertheless, the comparative efficiency and safety of ESD, surgery and d-CRT for cT1N0M0 EC remain unclear.

AIM

To compare the efficiency and safety of ESD, surgery and d-CRT for cT1N0M0 EC.

METHODS

We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th, 2022. We analyzed demographic, medical recorded, histopathologic characteristics, imaging and endoscopic, and follow-up data. The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments. Inverse probability of treatment weighting (IPTW) was used to minimize potential confounding factors.

RESULTS

We retrospectively analyzed patients who underwent ESD (n = 99) or surgery (n = 220) or d-CRT (n = 16) at the Sun Yat-sen University Cancer Center from 2017 to 2019. The median follow-up time for the ESD group, the surgery group, and the d-CRT group was 42.0 mo (95%CI: 35.0-60.2), 45.0 mo (95%CI: 34.0-61.75) and 32.5 mo (95%CI: 28.3-40.0), respectively. After adjusting for background factors using IPTW, the highest 3-year overall survival (OS) rate and 3-year recurrence-free survival (RFS) rate were observed in the ESD group (3-year OS: 99.7% and 94.7% and 79.1%; and 3-year RFS: 98.3%, 87.4% and 79.1%, in the ESD, surgical, and d-CRT groups, respectively). There was no difference of severe complications occurring between the three groups (P ≥ 0.05). Multivariate analysis showed that treatment method, histology and depth of infiltration were independently associated with OS and RFS.

CONCLUSION

For cT1N0M0 EC, ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery, with a similar rate of severe complications occurring.

Keywords: Retrospective study; cT1N0M0; Esophageal squamous cell carcinoma; Endoscopic submucosal dissection; Surgery; Definitive chemoradiotherapy

Core Tip: This is a first retrospective study to compare overall survival, recurrence-free survival and complication rates of endoscopic submucosal dissection (ESD), surgery and definitive chemoradiotherapy (d-CRT). In this study, we found that ESD attained better survival benefits and lower hospitalization costs than surgery and d-CRT, and they had similar complication rates. This study provides a more comprehensive analysis of the efficacy and safety of current cT1N0M0 esophageal cancer (EC) treatment patterns and provides new evidence for the use of ESD in cT1N0M0 EC.