Prognosis of Diffusely Infiltrative Esophageal Squamous Cell Carcinoma After Radical Esophagectomy

Diffusely infiltrative esophageal squamous cell carcinoma is rare, and the benefit of surgical resection for this disease remains unclear. In this study, we investigated the prognosis of diffusely infiltrative squamous cell carcinoma compared with other macroscopic types of locally advanced esophageal cancer. Additionally, we aimed to identify prognostic factors for this disease.

Eligible patients were limited to macroscopic types 1 to 4 with histological classification restricted to squamous cell carcinoma. Patients who underwent R2 resection were excluded, resulting in 850 patients being selected for analysis. The eligible patients were divided into two groups: Type 4 and non-Type 4. Survival rates were calculated using the Kaplan-Meier method with statistical significance assessed via the log-rank test. Prognostic factors were evaluated using Cox proportional hazards regression.

No significant differences in patient background characteristics or preoperative factors were observed between Type 4 and non-Type 4 groups. However, postoperative pathological findings revealed that Type 4 had a significantly greater number of lymph node metastases. Univariate and multivariate analyses identified Type 4 as an independent poor prognostic factor. Furthermore, the Type 4 group had more pleural recurrences and shorter survival times after recurrence than the non-Type 4 group.

Type 4 esophageal cancer itself was an independent poor prognostic factor, possibly because of the greater number of pathological nodal metastases and poor responsiveness after recurrence. Although approximately 20% of patients who underwent esophagectomy could achieve long-term survival, further development of multidisciplinary treatment for Type 4 esophageal cancer is crucial.