Published online Dec 7, 2018. doi: 10.3748/wjg.v24.i45.5154
Peer-review started: September 2, 2018
First decision: October 14, 2018
Revised: October 22, 2018
Accepted: November 13, 2018
Article in press: November 13, 2018
Published online: December 7, 2018
Processing time: 98 Days and 10.6 Hours
The prognosis of superficial (T1) esophageal squamous cell carcinoma (ESCC) is poor, compared with T1 gastric or colorectal cancer. The unfavorable prognosis of patients with T1 ESCC is due to high rates of both synchronous and metachronous metastases. Recurrences of T1 ESCC after esophagectomy are usually metachronous metastases. When recurrence occurs, the prognosis is similar in patients who were node-negative or node-positive at the time of the original surgery. However, only a few studies have evaluated the clinicopathological characteristics associated with an increased risk of a postoperative recurrence in pT1N0 ESCC patients. No previous studies have separately evaluated the clinicopathological characteristics that are associated with distant recurrence or early recurrence in pT1N0 ESCC patients.
The identification of pT1N0 ESCC cases at high risk for recurrence is a very important and challenging aspect of the clinical management of these patients, to ensure appropriate use and maximum benefit of additional therapies.
To investigate the clinicopathological characteristics that are associated with recurrence, distant recurrence, and early recurrence, in order to provide clues to optimal individual therapy.
Clinicopathological characteristics associated with any recurrence or distant recurrence were evaluated using univariate and multivariate Cox proportional hazards models. Early recurrence (≤ 24 mo) and correlated parameters were assessed using univariate and multivariate logistic regression models.
We have identified certain clinicopathological features that are associated with an increased risk of tumor recurrence in pT1N0 thoracic ESCC patients. A nomogram including tumor location, angiolymphatic invasion, and submucosal invasion thickness can be used to predict the likelihood of recurrence-free survival at different times after surgery. Patients with an upper thoracic tumor location and/or angiolymphatic invasion have a higher risk of distant recurrence. Patients with an upper thoracic tumor location, angiolymphatic invasion, submucosal invasion thickness, and an greater diameter of the largest single tongue of invasion have a higher risk of early recurrence. Additional long-term follow-up studies are needed to confirm these findings.
We evaluated the clinicopathological characteristics associated with an increased risk of a postoperative recurrence and separately evaluated the clinicopathological characteristics that are associated with distant recurrence or early recurrence in pT1N0 ESCC patients. This study should help clinicians select a subset of these patients who need especially close postoperative surveillance and/or chemoradiotherapy.
Risk of tumor recurrence in pT1N0 ESCC patients can be predicted using certain clinicopathological features. This should be confirmed in more prospective studies and multi-center studies.