Efficacy Of CRT Or Esophagectomy After Non-curative Endoscopic Submucosal Dissection For Esophageal Squamous-cell Carcinoma

Objective To investigate the outcomes of superficial esophageal squamous-cell carcinoma patients who underwent CRT or esophagectomy therapy after non-curative endoscopic submucosal dissection.Methods We retrieved clinicopathological data of 182 patients(mean age 65.6±7.0 years,124 men)of esophageal cancer who underwent ESD was performed from July 2014 to April 2019 in the Zhongda Hospital.There were 103 patients in curative resection group and 79 patients in non-curative group.In non-curative group,there were 31 patients without additional treatment,36 patients with chemoradiotherapy(CRT)and 12 patients with esophagectomy.The rates of en bloc resection(R0resection),overall survival(OS),relapse-free survival(RFS),and adverse events were evaluated.Results There was statistical difference in terms of OS(P=0.044)and RFS(P=0.019)rates between curative and non-curative groups.Within non-curative group,RFS rate(P=0.032)between no additional treatment and additional treatment groups has statistical difference,but the OS rate(P=0.198)among no additional treatment group,CRT group and esophagectomy groups didn’t significantly differ.Independent factors for cancer recurrence were(1)tumor infiltration depth to submucosal(P=0.030,HR0.315),(2)LVI(P=0.044,HR=6.329),(3)R1 resection(P=0.023,HR=3.328)and(4)no complementary treatment after ESD(P=0.002,HR=0.125).Conclusion Patients in curative resection group showed better long-term survival and relapse-free survival outcomes compared with non-curative group.Within non-curative group,patients achieved a higher relapse-free survival rates with additional treatments.The strategy of additional CRT or esophagectomy is an effective treatment for non-curative resection patients.