Endoscopic submucosal tunnel dissection for early esophageal squamous cell carcinoma in patients with cirrhosis: A propensity score analysis

Table 1 Baseline characteristics of unmatched and matched cohort

Variable	Unmatched cohort			Matched cohort
	Cirrhosis, n = 28	Noncirrhosis, n = 537	P value	Cirrhosis, n = 25	Noncirrhosis, n = 75	P value
Sex, male	22 (78.6)	373 (69.5)	0.305	19 (76.0)	56 (74.7)	0.894
Age, yr (SD)	59.8 (8.2)	62.5 (7.9)	0.081	59.3 (8.5)	60.8 (8.3)	0.424
Location			0.027			0.427
Upper	3 (10.7)	42 (7.8)		2 (8.0)	2 (2.7)
Middle	12 (42.9)	360 (67.0)		14 (56.0)	42 (56.0)
Lower	13 (46.4)	135 (25.2)		9 (36.0)	31 (41.3)
Circumference			0.200			0.637
> 1/2, < 3/4	16 (57.1)	369 (68.7)		14 (56.0)	46 (61.3)
≥ 3/4	12 (42.9)	168 (31.3)		11 (44.0)	29 (38.7)
Macroscopic type[20]			< 0.01			0.137
IIa + IIb/Is/IIa	4 (14.3)	281 (52.3)		6 (24.0)	7 (9.3)
IIb	14 (50.0)	231 (43.0)		13 (52.0)	52 (69.3)
IIb + IIc/IIc/IIa + IIc	10 (35.7)	25 (4.7)		6 (24.0)	16 (21.4)
Area, cm2 (SD)1	13.5 (6.7)	13.8 (9.6)	0.828	14.1 (6.9)	13.6 (8.9)	0.810
Invasion depth			0.379			1.000
EP/LPM	23 (82.1)	471 (87.7)		21 (84.0)	62 (82.7)
MM/SM1	5 (17.9)	66 (12.3)		4 (16.0)	13 (17.3)

¹The area was calculated by multiplying the length by the width.

Values are mean or n (%). EP: Mucosal epithelium; LPM: Lamina propria mucosae; MM: Muscularis mucosae; SM1: Infiltrate the upper 1/3 of the submucosa; SD, standard deviation.

Table 2 Characteristics of early esophageal squamous cell carcinoma patients with comorbid liver cirrhosis¹

Cirrhosis group characteristics	Value
Cause of liver cirrhosis
Hepatitis B	9 (36.0)
Hepatitis C	1 (4.0)
Alcohol	13 (52.0)
Autoimmune hepatitis	2 (8.0)
Ascitic fluid
No	14 (56.0)
Yes	11 (44.0)
Total bilirubin, μmol/L (SD)	21.0 (9.6)
Albumin, g/L (SD)	38.0 (5.6)
Prothrombin time, s (SD)	12.9 (1.7)
Child-Pugh score13, n (SD)	6.0 (1.3)
Child-pugh classification[13]
A	15 (60.0)
B	9 (36.0)
C	1 (4.0)
Esophageal varices and grade[14]
Yes, mild esophageal varices	4 (16.0)
Yes, severe esophageal varices	6 (24.0)
No	15 (60.0)
Gastric varices and Sarin type[21]
Yes, GOV-1	3 (12.0)
Yes, GOV-2	1 (4.0)
Yes, IGV	1 (4.0)
No	20 (80.0)
EVL	3
ETAI	1
TIPS	3
Lesions on esophageal varices
Yes	4 (16.0)
No	21 (84.0)

¹All parameters and treatments were measured and performed before endoscopic submucosal tunnel dissection.

Values are mean, median, or n (%). SD: Standard deviation; GOV: Gastroesophageal varices; IGV: Isolated gastric varices; EVL: Esophageal variceal ligation; ETAI: Endoscopic tissue adhesive injection; TIPS: Transjugular intrahepatic portosystemic shunt.

Table 3 Endoscopic efficacy and safety in patients with or without liver cirrhosis underwent endoscopic submucosal tunnel dissection

Clinical data	Cirrhosis (n = 25)	Noncirrhosis (n = 75)	P value
Number of tunnels			0.430
Single tunnel	17 (68.0)	57 (76.0)
Multiple tunnels	8 (32.0)	18 (24.0)
R0 resection	22 (88.0)	65 (86.7)	1.000
Curative resection	19 (76.0)	57 (76.0)	1.000
Dissection speed, mm²/min (SD)	24.5 (11.6)	21(11.8)	0.200
Intraoperative bleeding	12 (48.0)	26 (34.7)	0.234
30-d post-ESTD bleeding	2 (8.0)	0 (0)	0.099
Muscular injury	5 (20.0)	23 (30.7)	0.304
Prednisone used post-ESTD	5 (20.0)	18 (24.0)	0.681
Stenosis	2 (8.0)	12 (16.0)	0.506
Perforation	0 (0)	3 (4.0)	0.735
Post-ESTD fever	11 (44.0)	21 (28.0)	0.137
Post-ESTD pneumonia	2 (8.0)	16 (21.3)	0.229
Hospitalization, day (SD)	14.9 (7.5)	10.3 (4.5)	0.007
Post-ESTD duration, d (SD)	6.5 (2.9)	6.1 (2.9)	0.523
Hospitalization costs, $ (SD)	4985.9 (1815.7)	4083.8 (759.0)	0.023
Median follow-up time, months	45	39	0.430
Local Recurrence	1 (4)	3 (4)	1.000
OS	17 (68.0)	71 (94.7)	0.001
DSS	24 (96.0)	75 (100.0)	0.075
RFS	24 (96.0)	72 (96.0)	0.8196

Values are mean, median, n, or n (%). ESTD: Endoscopic submucosal tunnel dissection; OS: Overall survival; DSS: Disease-specific survival; RFS: Recurrence-free survival; SD: Standard deviation.