| Objective:To explore the survival and prognosis of superficial esophageal squamous cell carcinoma with infiltration depth of the muscularis mucosa(M3)and submucosa(SM)after endoscopic and surgical treatment,and evaluate the prognosis of the two treatment methods related risk factors to guide patients with sESCC to choose the treatment that benefits the most.Methods:Collected clinical case data of ESCC patients from January 2015 to December 2019,at the Thoracic Surgery and Digestive Center of Subei People’s Hospital of Jiangsu Province,who underwent radical surgery or ESD treatment and the pathology was confirmed that the depth of tumor invasion was the muscularis mucosa(M3)and submucosa(M3).among them,patients who underwent esophagectomy were classified as surgical group,and ESD as endoscopic group.The Matchlt data package in R 4.04 statistical software was used to conduct propensity score matching(PSM)for the two groups of patients,and the parameters were set to ratio=3:1,caliper=0.02.Then use SPSS 25.0 statistical software to perform statistical processing after PSM.If continuous variables conform to normal distribution,use independent sample T test,and use independent sample nonparametric test if not;use Pearson chi-square or fisher’s exact inspection for categorical variables The survival data were calculated and drawn by Kaplan-Meier method,and the log-rank or Wilcoxon(Gehan)test was used to perform univariate analysis to evaluate the survival difference between the two groups of observation variables.Cox regression model was used to analyze the independent risk factors of the two groups of data before PSM.P<0.05 indicates that the difference is statistically significant.Results:After performing PSM with gender,tumor location,and depth of invasion as matching variables,a total of 125 patients were matched,84(67.2%)in the surgical group and 41(32.8%)in the endoscopy group.There were 84 males(67.2%)and 41 females(32.8%),with an average age of(64.7±6.7)years.There is no statistical difference in general information between the two groups.In the perioperative clinical data,there were still statistical differences between the two groups after PSM for the length of operation(P<0.001),intraoperative blood loss(P<0.001),postoperative hospital stay(P<0.001),number of lymph nodes dissected(P<0.001),number of positive lymph nodes(P=0.019),upper/level positive resection margin(P<0.001),lung infection(P=0.03),anastomotic/esophageal stenosis(P=0.038),anastomotic leakage/esophageal perforation(P=0.037).In the survival data,the whole group was followed up for 8-73 months,with an average follow-up time of(47.0±15.0)months.To the end of the follow-up,a total of 8 patients(6.4%)died,and the OS was 99.2%,94.8%,91.4%at 1,3,and 5 years after operation;a total of 13 patients(10.4%)had recurrence and metastasis,and the DFS at 1 year,3 years,and 5 years after surgery were 98.4%,91.6%,and 85.7%,respectively.Among them,there were 6 deaths in the surgical group,The 1-year,3-year,and 5-year OS of the patients were 98.8%,93.7%,and 90.8%,respectively;2 cases died in the endoscopy group,and the 1-year,3-year,and 5-year OS were 100%and 97.1%,93.2%,respectively.there was no statistical difference in OS survival curve between the two groups(P=0.740).In the surgical group,there were 7 cases of recurrence,and the 1-year,3-year,and 5-year DFS were 98.8%,93.9%,and 91.9%,respectively;in the endoscopic group,there were 6 cases of recurrence,and the 1-year,3-year,and 5-year DFS were 97.6%,86.7%and 83.1%.there was no statistical difference in DFS between the two groups(P=0.210).In the log-rank univariate analysis,there was no statistical difference in the effects of all observed variables on OS(P>0.05);while in DFS,only the degree of differentiation(P=0.015)was statistically different.Then the degree of differentiation and depth of invasion were further stratified and found that SM(P=0.048)and G3(P=0.014)had statistically different affecting DFS between the two groups.In the surgical group,Lymph node metastasis(HR=4.589,95%CI:1.285-16.384,P=0.019)and positive upper resection margin(HR=12.908,95%CI:4.406-37.816,P<0.001)are the factors affecting the OS of patients;while lymph node metastasis(HR=3.553,95%CI:1.223-10.319,P=0.02),positive upper margin(HR=20.210,95%CI:6.521-62.637,P<0.001),degree of differentiation(HR=2.982,95%CI:1.339-6.644,P=0.008)is an independent risk factor affecting DFS.In the endoscopy group,positive vertical resection margins(OS:HR=23.664,95%CI:1.434-390.484,P=0.027 AND HR=10.807,95%CI:1.967-59.379,P=0.006)and vascular cancer embolus(OS:HR=82.329,95%CI:3.335->1000,P=0.007 AND DFS:HR=15.825,95%CI:1.638-152.850,P<0.017)are independent risk factors for OS and DFS.Conclusion:1.For sESCC of the infiltration depth of M3 and SM,ESD can achieve the same short-term and long-term effects as surgical treatment,and it has more advantages in terms of operating time,intraoperative blood loss,postoperative hospital stay,and less postoperative complications,but in Lymph node dissection and R0 resection rate are inferior.2.G3 and SM are related to the disease-free survival of the whole group.It is recommended that patients with poorly differentiated or undifferentiated sESCC with submucosal infiltration are closely followed up3.Patients with sESCC with lymph node metastasis and positive upper margins after surgery are recommended to receive additional radiotherapy and chemotherapy;patients with poor differentiation are recommended to follow up closely.4.Patients with positive vertical resection margins and vascular tumor thrombus after ESD are recommended for postoperative chemotherapy or surgical treatment. |
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