Am J Gastroenterol：内镜切除术后食管癌转移率长期风险与浸润深度相关

　　近日，来自日本大阪的研究人员Takeshi Yamashina发表论文，指出内镜切除术（ER）后远期转归为食管癌的治疗提供了重要信息。该研究旨在调查食管癌内镜切除术后的生存率和转移情况。研究指出，ER术后转移率的长期风险主要与癌症浸润深度相关。这种风险应该作为是否进行ER的适应证。该文发表在《美国胃肠病学杂志》（Am J Gastroenterol 2013; 108:544–551）上。

　　1995年至2010年，570例食管癌患者采用ER治疗。其中，402例为鳞状细胞癌[280例食管黏膜上皮层鳞癌（EP）或黏膜固有层鳞癌（LPM），70例黏膜肌层癌（MM），52例黏膜下癌（SM）]都在分析之列。17例患者癌症浸润黏膜下层深度达0.2毫米（SM1），35例患者癌症浸润黏膜下层深度超过0.2毫米（SM2）。

　　在平均50（4-187）个月的随访中，EP/LPM，MM和SM患者5年总生存率分别为90.5%，71.1%和70.8%（P＝0.007）。多变量分析确认浸润深度和年龄为生存率的独立预测因素，与EP/LPM相比，风险比分别为MM 3.6，SM 3.2，年龄每年为1.07。EP/LPM，MM，SM1和SM2累计5年的转移率分别为0.4%，8.7%，7.7%和36.2%（P＜0.001）。多变量分析确认浸润深度为转移率的一个独立危险因素，与EP/LPM相比，风险比为MM 13.1，SM1 40.2，SM2 196.3。黏膜癌患者无论是否侵犯淋巴血管累计5年转移率分别为0.7%和46.7%（P＜0.0001）。

与食管癌相关的拓展阅读： 

• ASO：p53与食管癌化疗缓解率相关
• Radiother Oncol：N1小细胞食管癌治疗首选放化疗
• SCUENCE DAILY:多种生活方式因素或可降低食管癌风险
• J Clin Oncol :食管癌手术应集中于少数外科医师处施行
• 肺癌、食管癌治疗相关临床路径颁布 更多信息请点击：有关食管癌更多资讯

Long-term outcome and metastatic risk after endoscopic resection of superficial esophageal squamous cell carcinoma.
OBJECTIVES
Long-term outcomes after endoscopic resection (ER) provide important information for the treatment of esophageal carcinoma. This study aimed to investigate the rates of survival and metastasis after ER of esophageal carcinoma.
METHODS
From 1995 to 2010, 570 patients with esophageal carcinoma were treated by ER. Of these, the 402 patients with squamous cell carcinoma (280 epithelial (EP) or lamina propria (LPM) cancer, 70 muscularis mucosa (MM) cancer, and 52 submucosal (SM) cancer) were included in our analysis. Seventeen patients had cancer invading into the submucosa up to 0.2 mm (SM1) and 35 patients had cancer invading into the submucosa more than 0.2 mm (SM2).
RESULTS
The mean (range) follow-up time was 50 (4-187) months. The 5-year overall survival rates of patients with EP/LPM, MM, and SM cancer were 90.5, 71.1, and 70.8%, respectively (P=0.007). Multivariate analysis identified depth of invasion and age as independent predictors of survival, with hazard ratios of 3.6 for MM cancer and 3.2 for SM cancer compared with EP/LPM cancer, and 1.07 per year of age. The cumulative 5-year metastasis rates in patients with EP/LPM, MM, SM1, and SM2 cancer were 0.4, 8.7, 7.7, and 36.2%, respectively (P<0.001). Multivariate analysis identified depth of invasion as an independent risk factor for metastasis, with hazard ratios of 13.1 for MM, 40.2 for SM1, and 196.3 for SM2 cancer compared with EP/LPM cancer. The cumulative 5-year metastasis rates in patients with mucosal cancer with and without lymphovascular involvement were 46.7 and 0.7%, respectively (P<0.0001).
CONCLUSIONS
The long-term risk of metastasis after ER was mainly associated with the depth of invasion. This risk should be taken into account when considering the indications for ER.