Analysis of risk factors for disease recurrence after endoscopic submucosal dissection of early esophageal cancer

Abstract

BACKGROUND

Endoscopic submucosal dissection (ESD) is a minimally invasive, safe, and efficient treatment technique for patients diagnosed with early esophageal cancer. However, postoperative disease recurrence remains an important clinical challenge because it negatively alters patient prognosis and quality of life. As such, identification of relevant risk factors for recurrence can help optimize postoperative management strategies.

AIM

To assess factors that contribute to the risk for disease recurrence after ESD for early esophageal cancer.

METHODS

Clinical data from 210 patients diagnosed with early stage esophageal cancer, who underwent ESD at the authors’ center between March 2012 and March 2025, were retrospectively collected and analyzed. Patients were categorized into 2 groups according to postoperative disease recurrence: Recurrence (n = 30), and without recurrence (n = 180). Disease recurrence was defined as the appearance of new tumor lesions or pathologically confirmed tumor recurrence during the postoperative follow-up period. Risk factors associated with postoperative recurrence were identified using univariate and multivariate logistic regression analyses.

RESULTS

During the follow-up period, 30 patients experienced tumor recurrence, corresponding to a recurrence rate of 14.19%. Multivariate analysis revealed that poor differentiation was a significant potential cause of esophageal cancer recurrence [odds ratio (OR) = 1.782, 95% confidence interval (CI): 1.154-2.196; P < 0.001]. Tumors infiltrating the submucosa were more likely to recur than those penetrating the lamina propria or muscularis mucosa (OR = 1.573, 95%CI: 1.073-2.481; P < 0.001). Furthermore, inability to completely resect the tumor greatly increased the likelihood of recurrence (OR = 2.189, 95%CI: 1.193-3.125; P = 0.001). Tumor diameter ≥ 2 cm was an independent risk factor for postoperative recurrence (OR = 1.981, 95%CI: 1.482-2.862; P = 0.005).

CONCLUSION

Recurrence of early esophageal cancer after ESD is largely influenced by the degree of differentiation, depth of lesion invasion, complete resection status of the tumor, and tumor diameter.

Keywords: Endoscopic submucosal dissection; Early stage esophageal cancer; Risk factors; Relapse; Multivariate analysis

Core Tip: The disease recurrence rate after endoscopic submucosal dissection for early esophageal cancer was 14.19%. A low degree of differentiation, infiltration into the submucosa, incomplete tumor resection, and tumor diameter ≥ 2 cm were independent risk factors for postoperative recurrence. Accurate assessment of these risk factors can help inform personalized follow-up strategies and secondary treatment plans to increase patients’ chances of long-term survival.