Screening And Prognostic Follow-Up Study Of Early Esophageal Squamous Cell Carcinoma

Part Ⅰ:Cytosponge for Screening Early Esophageal Squamous Cell Carcinoma,Cardia Carcinoma and Precancerous LesionsObjective:Esophageal cancer and gastric cardia cancer are two common cancers in the world,and advanced esophageal cancer and gastric cardia cancer have a poor prognosis.Therefore,early diagnosis of esophageal cancer and cardiac cancer can help timely treatment and reduce the mortality of patients.The gradual development of endoscopy technology has gradually increased the detection rate of upper gastrointestinal tumors.With the gradual development of endoscopic technology,the detection rate of upper gastrointestinal tumors is also gradually increasing.However,endoscopy is highly technical and expensive,and is not suitable for screening the population.Therefore,we need a more simple and economical method for screening to screen out patients who need further examination.Therefore,our purpose is to evaluate the safety and effectiveness of using a new cell sampling device-sponge pull-net capsule(Cytosponge)to screen early esophageal and cardia cancers.To determine whether this new detection method can replace endoscopy as an effective screening method.Methods:Recruit patients who intend to undergo upper gastrointestinal ESD in the First Affiliated Hospital of Anhui Medical University from April 2020 to December 2020.The patients swallow the capsule before ESD surgery to make the capsule enter the cardia.In the process of drinking water,the shell of the capsule gradually dissolved,making the compressed sponge expand,and the expanded sponge can fully extract the cells of the mucous layer.The sponge that extracted the cells was put into the cell preservation solution and sent to the laboratory for cytological examination.The DNA index(DI value)of each cell was measured to determine whether there were abnormal cells.After receiving sponge pull-net capsule examination,patients will undergo standard endoscopy and ESD surgery,so we take the results of endoscopy and pathological diagnosis as the gold standard to calculate the sensitivity,specificity and accuracy of sponge pull-net capsule examination in the diagnosis of early esophageal and cardiac carcinoma.Results:A total of 185 patients participated in this study.Endoscopic and pathological diagnosis of 85 cases of esophageal disease,49 cases of cardia disease,51 cases of esophagus and cardia were normal.All patients swallowed the capsule successfully.There was no strong discomfort during and after the operation,and no adverse events occurred.Sponge pull net capsule has a good sensitivity for the detection of esophageal dysplasia + SCC,but the specificity is not high.Its sensitivity,specificity and accuracy are 78.82%,58.82% and 71.32% respectively,and the sensitivity,specificity and accuracy of detecting cardiac dysplasia + ACC are 65.91%,62.5% and 64%,respectively.For patients with early cardiac carcinoma,the positive rate of cytological diagnosis was related to the size of the lesion(P= 0.042).Conclusion:The Cytosponge is an acceptable,safe and effective screening method for early esophageal cancer.Cytosponge has high sensitivity and low specificity in screening early esophageal cancer.However,compared with the effect of screening early cardiac cancer,Cytosponge is more effective in screening early esophageal cancer.therefore,more samples are needed in the future to determine whether the cell sponge test can be used in the screening of early cardiac cancer.Part Ⅱ:A Retrospective Study of Surgical Treatment of Early Esophageal Squamous Cell CarcinomaObjective:To further explore the best patients suitable for endoscopic resection by evaluating the general information,Histological and pathological characteristics of early esophageal squamous cell carcinoma and the risk factors of lymph node metastasis after esophagectomy.Methods:Patients with early esophageal squamous cell carcinoma were collected in November 2011 to April 2019 to accept esophagectomy were 347 cases.The general and histological data of the patients were collated,and the overall incidence of lymph node metastasis rate was calculated.According to the detected lymph nodes,they were divided into two groups: lymph node metastasis negative group and lymph node positive group.The two groups were compared in gender,lesion size,age,lesion location,resection margin,tissue differentiation,depth of invasion,and lymphovascular invasion,and the risk factors affecting lymph node metastasis were further analyzed.The clinicopathological data of patients with LNM who met the ESD indications were analyzed to determine whether these patients have specific characteristics.Results:The overall lymph node metastasis rate of early esophageal squamous cell carcinoma was 9.51%.The frequency of lymph node metastasis in mucosal and submucosal cancer were 3.73% and 13.15%,respectively.The frequency of lymph node metastasis with different depth of invasion was: M1/M2 2.5%,M3 5.56%,SM 13.15%.The analysis revealed that lymph node metastasis positive group and negative group differences in the depth of tumor invasion statistically significant(P=0.012),while there were no statistically significant differences between the two groups in age,gender,lesion size,lesion location,resection margin,tissue differentiation and lymphovascular invasion(P>0.05).Univariate analysis showed that the depth of invasion(OR=3.91,95%CI: 1.47~10.38;P=0.006)was a risk factor for lymph node metastasis in early esophageal squamous cell carcinoma,and the number and region of lymph node metastasis were also associated with the depth of invasion.For patients with ESD indications,the patients whose lesion size ≥10mm,macroscopic type is elevated or depressed,and the degree of differentiation is moderately or poorly differentiated patients should be vigilant.Conclusion:The rate of lymph node metastasis of intramucosal carcinoma is low,but the surgical treatment is more traumatic,so we can choose less invasive treatment,such as endoscopic resection.For patients with submucosa,esophagectomy and lymph node dissection are the first-line treatment,and at least 2-field lymphadenectomy is required.Part Ⅲ:A Retrospective Study of Short-term Outcome after Endoscopic Submucosal Dissection of Early Esophageal Squamous Cell CarcinomaObjective:To evaluate the indications and efficacy of endoscopic submucosal dissection(ESD)and the criteria of additional treatment after ESD for early esophageal squamous cell carcinoma by analyzing the clinicopathological characteristics and short-term outcome of ESD in the treatment of early esophageal squamous cell carcinoma.Methods:This study included a total of 328 lesions in 289 patients with early esophageal squamous cell carcinoma who underwent ESD in the Department of Gastroenterology of the First Affiliated Hospital of Anhui Medical University from January 2018 to November 2019.And then,we analyzed the general clinical data,ESD treatment,histological and pathological data of resected specimens and follow-up data.According to the lymphovascular invasion(LVI)diagnosed by histology and pathology,the patients were divided into two groups: LVI negative group and LVI positive group.The differences in gender,age,lesion size,lesion location,lesion circumference,macroscopic type,resection margin and depth of invasion were compared between the two groups.The independent risk factors of LVI were evaluated by binary logistic regression analysis.The results of the re-examination of patients were followed up after ESD,the follow-up results were recorded in detail,and the additional treatment of the patients in the follow-up results were analyzed in detail.Results:The analysis of LVI,found that the lesion size,the circumference of the lumen,the depth of invasion and the resection margin were related to LVI.Multivariate analysis showed that the circumference of the lumen and the depth of invasion were independent risk factors for LVI.The en bloc resection rate was 100%(328/328),the complete resection rate was 94.51%(310/328),and the curative resection rate was 89.33%(293/328).The incidence of postoperative complications was 0.75%(2/267)of postoperative delayed bleeding,stenosis 4.49%(12/267),and no patient had perforation.The overall recurrence rate was 0.75%(2/267).A total of 23 patients underwent additional surgery or adjuvant treatment after ESD.There was not any additional treatment in group A(pCurA),radiotherapy was the main additional treatment in group B(pCurB),and surgery was the main additional treatment in group C(pCurC).Conclusion:For patients with early esophageal cancer whose depth of invasion does not exceed SM1 and there is no lymph node metastasis,ESD is safe and effective,and the short-term prognosis is good.Patients with lesion circumference ≥3/4 or deep invasion are independent risk factors for LVI,which should be paid attention to in preoperative evaluation.In postoperative evaluation,patients with pCurA or pCurB should be closely followed up,while patients with pCurC should be actively supplemented with surgery or adjuvant treatment.