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Comparative Study
. 2025 Jan;60(1):43-54.
doi: 10.1007/s00535-024-02188-7. Epub 2024 Dec 3.

Comparison of outcomes between surgery and chemoradiotherapy after endoscopic resection for pT1a-MM with lymphovascular invasion or pT1b esophageal squamous cell carcinoma: Japanese multicenter propensity score-matched study

Yoshinobu Yamamoto  1 , Ryu Ishihara  2 , Hirofumi Kawakubo  3 , Michiko Nishikawa  1 , Sachiko Yamamoto  4 , Tomohiro Kadota  5 , Seiichiro Abe  6 , Masao Yoshida  7 , Tsutomu Tanaka  8 , Hiroaki Nagano  9 , Hiroyoshi Nakanishi  10 , Tetsuya Yoshizaki  11 , Kotaro Waki  12 , Akiko Takahashi  13 , Yoshiyasu Kitagawa  14 , Kenichi Mizuno  15 , Kenro Kawada  16 , Yoshiyasu Kono  17 , Chikatoshi Katada  18 , Takashi Hashimoto  19 , Yasuaki Nagami  20 , Toshiyuki Yoshio  21 , Toshio Shimokawa  22 , Keiji Nihei  23 , Kazuo Koyanagi  24 , Ken Kato  25 , Tomonori Yano  5 , Manabu Muto  26 , Yuko Kitagawa  3
Affiliations
Comparative Study

Comparison of outcomes between surgery and chemoradiotherapy after endoscopic resection for pT1a-MM with lymphovascular invasion or pT1b esophageal squamous cell carcinoma: Japanese multicenter propensity score-matched study

Yoshinobu Yamamoto et al. J Gastroenterol. 2025 Jan.

Abstract

Background: Lymphovascular invasion (LVI) or pT1b is noncurative after endoscopic resection (ER) for esophageal squamous cell carcinoma (ESCC), and therefore surgery or chemoradiotherapy (CRT) is recommended. However, there has been debate regarding which treatment has better outcomes and whether individual risks should be considered.

Methods: This was a multicenter, retrospective study conducted at 65 hospitals in Japan. The inclusion criteria were patients with ESCC who underwent ER between January 2006 and December 2015, with pT1a-muscularis mucosa (MM) with LVI or pT1b, with negative vertical margins, cN0M0, and who underwent surgery or CRT. A 1:1 propensity score-matched analysis was performed between two groups. The primary and secondary end points were overall survival (OS) and relapse-free survival (RFS). OS and RFS were also compared between two subgroups: low risk (pT1a-MM with LVI and pT1b without LVI) and high risk (pT1b with LVI) for metastatic recurrence.

Results: Among 472 patients, 160 patients were selected from each group. The OS and RFS did not differ between surgery and CRT groups (hazard ratio, 0.887; P = .635 and hazard ratio, 1.036; P = .876, respectively). Subgroup analysis showed that CRT had a better prognosis in the low-risk group, and conversely, surgery had a better prognosis in the high-risk group. But these were not significant. The high-risk CRT group had a significant worse prognosis than the low-risk CRT group.

Conclusions: In patients with noncurative ER for ESCC, surgery and CRT showed no difference in long-term outcomes. Indications for CRT in the high-risk group need further investigation because of poor prognosis.

Keywords: Additional treatment; Endoscopic resection; Esophageal squamous cell carcinoma; Lymphovascular invasion; Submucosal invasion.

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Conflict of interest statement

Declarations. Conflict of interest: All authors declare that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Study flowchart. a Some patients were excluded for one or more reasons
Fig. 2
Fig. 2
Overall survival and relapse-free survival in the surgery and CRT groups. a Overall survival. b Relapse-free survival
Fig. 3
Fig. 3
Overall survival and relapse-free survival in the surgery and CRT group divided into two subgroups (low-risk group and high-risk group). a Overall survival. b Relapse-free survival
See this image and copyright information in PMC

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