| Objective:To summarize and analyze the differences between the two treatments by describing the clinicopathological characteristics,analyzing postoperative survival rates and causes of death of superficial esophageal cancer,so that we can provide methods for improving the diagnosis and treatment of superficial esophageal cancer and further propose proper explanations and solutions.We would like to expand the indications of endoscopic surgery,in order to give patients guidelines of the treatment methods and improve the quality of life and prognosis of patients.Methods:We retrospectively analyzed the patients who underwent ESD(117)or radical surgery(217)in the first Affiliated Hospital of Nanchang University from January 1,2010 to December 31,2018.All patient information came from the Department of Pathology and Medical record system to establish a database of patient clinical data,including age,gender,chronic diseases(mainly including diabetes,hypertension),smoking and drinking history,family history of tumor among first degree relatives,diagnosis year,tumor characteristics(morphology,location,and lesion size),cancer stages,degree of differentiation,endoscopic diagnosis,Paris endoscopic classification,pathological characteristics(including pathological type,depth of invasion,resection margin,lymphatic vessel invasion,all completed by 2 pathologists),intraoperative adjuvant treatment,radiotherapy and chemotherapy,intraoperative and postoperative complications(including bleeding,perforation,fever,etc.),length of hospital stay,hospitalization costs,curative resection rate,complete resection rate,follow-up results,death(cause of death),etc.SPSS25.0 software was used for data analysis,the comparison between groups was tested by the Log-rank method,Kaplan-meier method was used for survival analysis,and the Log-rank method was used for the significance test of the survival rate.Theχ2 test was used to compare the count data,the t test was used to compare the measurement data,and the Fisher exact probability method was used to compare the small sample rate.Univariate analysis and multivariate analysis adopt Cox proportional hazard regression model,and R language software is used for propensity scoring analysis.Results:1.Patients in the ESD group were older(median 63.49 vs 61.6 years,P=0.05),had a higher proportion of histologically well differentiated(48.7%vs 16.1%,P<0.001),and more tumors were located in the middle(79.5%vs 63.1%,P=0.007),lower vascular invasion rate(2.6%vs 10.6%,P<0.009),higher resection margin positive rate(12%vs 1.8%,P<0.001),higher proportion of Carcinoma in situ(37.6%vs 10.6%,P<0.001)and squamous cell carcinoma(22.19%vs 21.5%,P=0.032),and the proportion of Paris type IIb is higher(51.3%vs 15.7%,P<0.001).The ESD group also showed a larger body mass index(mean 22.19 vs 21.5,P<0.03)(kg/m~2),and the incidence of choosing chemical/radiotherapy after treatment was lower(2.6%vs10.6%,P=0.009).The number of smokers and drinkers in the surgery group are more higher(48.4%vs 31.6%,P=0.003;34.6%vs 23.1%,P=0.03,respectively),but the two groups had no significant difference in gender,tumor length,tumor family history,diabetes,and hypertension.2.After propensity scoring match,the two groups were matched to produce 67pairs of patients.The overall survival rate and progression-free survival rate of the ESD group were better than those of the surgery group(OS,P=0.002.PFS,P=0.004).The ESD group had a lower incidence of early adverse events(74.6%vs 91%,P=0.012),shorter hospital stays(median 10 days vs 18 days,P<0.001),and lower hospital costs(median 15455 vs 62376 RMB,P<0.001).The complete resection rate and curative resection rate were higher in the ESD group(97%vs 95.52%,95.38%vs93.75%,respectively).Multivariate Cox regression analysis found that the treatment method was an independent risk factor affecting the prognosis of patients with superficial esophageal cancer,and the death risk of patients in the ESD group was0.377 times that of the radical surgery group(HR=0.377,P=0.023).3.We conducted a subgroup analysis of patients again according to the depth of invasion,37 pairs of patients were included in T1a stage,and 19 pairs of patients were included in T1b stage.In T1a and T1b patients,the difference in OS rate and PFS rate between the two treatments was statistically significant(T1a,OS,P=0.002,PFS,P=0.004;T1b,OS,P=0.019,PFS,P=0.022),and the OS rates in the ESD group were better than those in the radical surgery group.Conclusion:1.In patients with superficial esophageal cancer confined to the mucosa,not only the overall survival rate and progression-free survival rate of patients in the ESD group are better than those of radical resection,but also the early adverse events,length of stay and hospitalization costs are better than those in the surgery group.2.For patients with T1a and T1b superficial esophageal cancer,compared with radical surgery,ESD has a longer overall survival and progression-free survival.3.These results support ESD as the preferred treatment for stage T1a and T1b superficial esophageal cancer. |
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