Outcomes of additional chemotherapy for esophageal squamous cell carcinoma following non-curative endoscopic...

Pathological T1a-muscularis mucosa with lymphovascular invasion and T1b-submucosa are high-risk factors for lymph node metastasis in esophageal squamous cell carcinoma (ESCC). Esophagectomy and chemoradiotherapy are recommended following endoscopic submucosal dissection (ESD) but can lead to complications. Here, we evaluated the efficacy and safety of chemotherapy following ESD.

This prospective and retrospective study included patients with pathological T1a-muscularis mucosa with lymphovascular invasion or T1b-submucosa who underwent esophageal ESD between June 2006 and August 2023, followed by chemotherapy or chemoradiotherapy. The overall survival, cause-specific survival, recurrence-free survival, hospitalization period, and the occurrence of grade ≥ 3 adverse events were compared between the chemotherapy and chemoradiotherapy groups.

The patient and tumor characteristics and pathological findings did not significantly differ between the chemotherapy (n = 16) and chemoradiotherapy (n = 15) groups. The 5-year overall and recurrence-free survival rates were significantly higher in the chemotherapy group than in the chemoradiotherapy group (100.0% vs. 77.8%, P < 0.001 and 92.3% vs. 84.9%, P = 0.007, respectively; log-rank test). The 5-year cause-specific survival rate did not significantly differ between groups (100.0% vs. 83.3%, P = 0.14, log-rank test). The hospitalization period was significantly shorter in the chemotherapy group than in the chemoradiotherapy group (34 vs. 48 days, P < 0.001). Grade ≥ 3 adverse events occurred in 4 (25.0%) and 11 (73.3%) patients in the chemotherapy and chemoradiotherapy groups, respectively.

Chemotherapy is a safe and effective additional treatment for ESCC (pathological T1a-muscularis mucosa with lymphovascular invasion or T1b-submucosa) after ESD.