224. ENDOSCOPIC TREATMENT OUTCOMES AND LONG-TERM PROGNOSIS FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA WITH PREOPERATIVE DEPTH EP/LPM

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Abstract Background Endoscopic resection is widely performed for superficial esophageal squamous cell carcinoma (ESCC), with clinical (c)EP/LPM being a particularly good indication. However, in some cases, pathological findings reveal a deeper invasion than initially predicted, requiring additional treatment. This study aimed to clarify the long-term outcomes of endoscopic resection for ESCC with cEP/LPM. Additionally, we examined the endoscopic features of cases in which pathological depth were MM (muscularis mucosae) or deeper. Methods A retrospective study was conducted on 723 patients with 1121 lesions diagnosed as ESCC with cEP/LPM and treated with endoscopic resection (ESD or EMR-C) at our institution between January 2011 and December 2020. Lesions with submucosal invasion or lymphovascular invasion were classified as high risk for metastasis, while all others were categorized as low risk. We calculated the low-risk lesion rate and the positive predictive value (PPV) of preoperative depth assessment and analyzed the characteristics of ESCCs with pMM or deeper. Results The average age was 68 years, with 85% male patients. Depth assessment showed 93.0% for pEP/LPM, 5.4% for pMM, 0.5% for pSM1, and 1.0% for pSM2. High-risk lesions accounted for 2.9%. The mean tumor size was 27.1 mm. Additional treatments for high-risk cases included surgery, chemoradiotherapy, proton therapy, or observation. The median observation period was 65 months, with a 5-year survival rate of 67%, similar to low-risk patients (70%). No metastatic recurrence or disease-specific deaths occurred. Six deaths were recorded, due to cancer, pneumonia, or other causes. The study suggests effective management of high-risk lesions. Conclusion The long-term outcomes of endoscopic resection for cEP/LPM ESCCs were favorable for both high-risk and low-risk lesions. Although cases with deeper invasion were rare, they did occur. Although rare, ESCC cases of deeper invasion were observed.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.