Comparison Of Endoscopic Submucosal Dissection And Esophagectomy In Patients With Early Esophageal Squamous Cell Carcinoma And Research On The Relative Prognosis

Objective Esophagectomy combined with regional lymphnode dissection is the standard treatment for esophageal cancer.In recent years,endoscopic submucosal dissection(ESD)has been a preferred treatment option for early esophageal squamous cell carcinoma(EESCC).We aimed to compare the outcomes of ESD and esophagectomy in the treatment of EESCC,and explore the value of preoperative serological markers in predicting its prognosis.Methods We retrospectively analyzed data from patients with EESCC who were diagnosed in the First Affiliated Hospital of USTC,including age,gender,cigarette,alcohol,family history,tumor characteristics(location,size,morphology,invasion depth,and histologic type),LVI,estimated blood loss,procedure duration,hospital stay,hospital cost,and adverse events,and then followed-up with them.Patients were divided into ESD and esophagectomy groups according to treatment.Propensity score matching(PSM)was performed to compare overall survival(OS),disease-specific survival(DSS),recurrence-free survival(RFS),and treatment-related events between the two groups.Cox proportional hazards models were performed to identify the independent factors of survival.In addition,patients with complete serologic data were identified.The receiver operating curves(ROC)were used to determine the optimal cut-off value of neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),lymphocyte to monocyte ratio(LMR),systemic immune-inflammation index(SII),and prognostic nutritional index(PNI).Kaplan–Meier curves and Cox proportional hazard model were used to identify independent risk factors associated with OS and RFS.Results1.Before matching,larger lesions were observed in the ESD group(3.48 vs 2.95 cm,P<0.001),while deep tumor infiltration,poorly differentiated lesions,and LVI were more common in the esophagectomy group.After matching,all baseline characteristics were not statistically different between the two groups.2.The ESD group showed less blood loss,shorter procedure duration and hospital stay,lower hospital cost,and fewer adverse events(all P<0.001).After matching,adjuvant treatment became different between the two groups(P<0.001).3.OS and DSS were significantly higher in the ESD group than that in the esophagectomy group.After matching,no significant differences were found between the ESD and esophagectomy groups in OS,RFS,and DSS.4.Subgroup analysis was performed for lesions that invading muscularis mucosa or submucosa.Patients who underwent ESD had larger tumor size(3.84 vs 3.01 cm,P<0.001),lower hospital costs,and shorter procedure duration and hospital stay(all P<0.001),but lower R0 resection rate and more adjuvant treatments.After matching,tumor size and adjuvant therapy became comparable,while adverse events showed statistically significant difference in the two groups.5.The optimal cut-off value of NLR,PLR,LMR,SII,and PNI were 3.23,157.74,2.37,451.25,and 45.00,respectively.6.Age,LVI,NLR ≥ 3.23,and PLR ≥ 157.74 were independent risk factors for OS of EESCC,while age and NLR ≥ 3.23 were independent risk factors for RFS of EESCC.Conclusion1.In the treatment of EESCC,ESD showed sufficient safety and advantages.Even for T1a-MM/T1b-SM ESCC,ESD may be an alternative treatment for EESCC.2.Age and NLR are independent risk factors for survival and recurrence in patientswith EESCC,and may provide potential predictive value for their prognosis.