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Metachronous carcinogenesis of superficial esophagus squamous cell carcinoma after endoscopic submucosal dissection: incidence and risk stratification during long-term observation

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Abstract

Background

This study aimed to reveal long-term outcomes, such as incidence of metachronous esophageal and head and neck squamous cell carcinomas and overall survival rate, through long-term observation of patients with esophageal carcinoma post-endoscopic submucosal dissection.

Methods

Risk of metachronous carcinogenesis was evaluated in 88 patients with intramucosal esophageal carcinoma (without history of metachronous esophageal or head and neck squamous cell carcinomas) who underwent endoscopic submucosal dissection from 2007 to 2008 and were endoscopically observed for > 3 years. Histologically, the papillary vessel is defined as the clock gear-like structure composed of capillaries directly penetrating the epithelium (starting from the lamina propria) and covering at least two-thirds of it, around which the tumor cells are arranged in a spiral pattern.

Results

Median endoscopic follow-up period was 11.0 years. Cumulative 2-, 5-, and 10-year metachronous esophageal carcinoma rates were 11.4%, 20.6%, and 39.3%, respectively. Stepwise multivariate Cox proportional hazard regression analysis identified multiple Lugol-voiding lesions (LVLs) as the single significant independent predictor. Cumulative 2-, 5-, and 10-year metachronous head and neck squamous cell carcinoma rates were 6.9%, 10.4%, and 19.6%, respectively. Stepwise multivariate Cox proportional hazard regression analysis identified multiple LVLs, Brinkman index, papillary vessel, and younger age as significant predictive factors. Overall post-endoscopic submucosal dissection survival rates were 98.8% and 87.5% at 5 and 10 years, respectively.

Conclusion

Patients with a history of esophageal carcinoma remain at risk for metachronous carcinogenesis even > 5 years after endoscopic submucosal dissection. Thus, long-term follow-up is important.

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Authors and Affiliations

  1. Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan

    Nobuhiko Ogasawara, Daisuke Kikuchi, Yorinari Ochiai, Junnosuke Hayasaka, Yugo Suzuki, Nobuhihiro Dan, Takayuki Okamura, Yutaka Mitsunaga, Masami Tanaka, Kosuke Nomura, Hiroyuki Odagiri, Satoshi Yamashita, Akira Matsui, Shu Hoteya & Toshiro Iizuka

  2. Department of Pathology, Toranomon Hospital, Tokyo, Japan

    Naoko Inoshita, Atsuhito Nakayama & Kei Kohno

Authors
  1. Nobuhiko Ogasawara
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  2. Daisuke Kikuchi
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  3. Naoko Inoshita
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  4. Atsuhito Nakayama
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  5. Kei Kohno
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  6. Yorinari Ochiai
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  7. Junnosuke Hayasaka
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  8. Yugo Suzuki
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  9. Nobuhihiro Dan
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  10. Takayuki Okamura
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  11. Yutaka Mitsunaga
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  12. Masami Tanaka
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  13. Kosuke Nomura
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  14. Hiroyuki Odagiri
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  15. Satoshi Yamashita
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  16. Akira Matsui
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  17. Shu Hoteya
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  18. Toshiro Iizuka
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Corresponding author

Correspondence to Daisuke Kikuchi.

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Ethical Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

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All authors declare that there is no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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Ogasawara, N., Kikuchi, D., Inoshita, N. et al. Metachronous carcinogenesis of superficial esophagus squamous cell carcinoma after endoscopic submucosal dissection: incidence and risk stratification during long-term observation. Esophagus 18, 806–816 (2021). https://doi.org/10.1007/s10388-021-00848-8

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  • DOI: https://doi.org/10.1007/s10388-021-00848-8

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