Individual risk stratification to predict metastasis for ESD of superficial esophageal squamous cell carcinoma

This study was aimed at identifying histopathological risk factors for metastasis and developing a reliable risk stratification system for superficial esophageal squamous cell carcinoma (sESCC) after endoscopic submucosal dissection (ESD).

Three hundred and thirty-one patients who underwent ESD from January 2009 to December 2019 and were pathologically confirmed as mucosal or submucosal cancer were included. Their clinicopathological characteristics were reviewed.

The median follow-up period was 51 months (range 12-132 months). We found 42 patients had recurrence, 16 metastasized (1 distant metastasis, 13 lymph node metastasis, 2 both distant and lymph node metastasis), and 24 patients died. This univariate analysis revealed five morphological features were significantly associated with metastasis and overall survival. They were invasive depth, tumor budding, differentiation, infiltrative growth pattern, and vessel invasion (P < 0.05). Vessel invasion (HR 3.635, 95% CI 1.063-12.435) was confirmed with multivariate analysis as independent risk factor for metastasis. The five factors were included in the risk stratification system and assigned scores (0-5). According to the 5-year non-metastasis rate, all cases were re-classed into a group of 293 low-risk tumors, and a group of 38 high-risk tumors. Our data revealed the metastasis rates of patients in high-risk group were significantly higher than those in low-risk group (P < 0.001).

Based on histopathological characteristics of ESD specimens, we developed a risk stratification system, which significantly divided sESCC into low-risk and high-risk group for metastasis. This may be used to assist in the decision-making process of sESCC to determine who need additional therapy after ESD.