Objective: To clarify the efficacy and safety of endoscopic submucosal dissection (ESD) with additional radiotherapy in T1a-MM/T1b-SM esophageal squamous cell carcinoma (ESCC). Methods: A retrospective analysis was conducted on 71 patients with T1a-MM/T1b-SM ESCC admitted to Southeast University Affiliated Zhongda Hospital from January 2015 to December 2019. The patients were divided into two groups based on the treatment method: the ESD group (ESD therapy alone) and the ESD-radiotherapy group (ESD combined radiotherapy). The follow-up duration after ESD was (44±17) months. The difference of disease-free survival (DFS) rate and overall survival (OS) rate between the two groups was compared by survival analysis, and the occurrence of complications was compared. Baseline variables of the two groups were compared and the influencing factors of DFS rate were analyzed by Cox proportional risk regression model. Results: There were 44 patients in the ESD-radiotherapy group [28 males, 16 females, aged (65±7) years] and 27 patients in the ESD group [18 males, 9 females, aged (67±9) years]. The results of survival analysis show that the 1, 3 and 5-year DFS rates of ESD-radiotherapy group were 95.5%, 92.9% and 77.4%, respectively, which were higher than those of ESD group 85.2%, 73.2% and 62.7% (all P<0.05). The 1, 3 and 5-year OS rates of the ESD-radiotherapy group were 100%, 94.7% and 94.7%, while those of the ESD group were 96.3%, 96.3% and 79.4%, respectively. The difference was not statistically significant (all P>0.05). Cox proportional hazard regression model analysis showed that ESD combined with radiotherapy (HR=0.19, 95%CI: 0.04-0.90, P=0.037), complete tumor resection (HR=0.25, 95%CI: 0.07-0.86, P=0.027), and vascular invasion (HR=12.06, 95%CI: 1.61-90.26, P=0.015) were the influencing factors of DFS rates. The most common complication of ESD was esophageal stenosis, and no grade 3 or higher radiation adverse reactions occurred after combined radiotherapy. Conclusion: ESD combined radiotherapy is an effective and safe therapeutic strategy for patients with T1a-MM/T1b-SM ESCC.
目的： 探讨内镜黏膜下剥离术（ESD）联合放疗治疗T1a-MM/T1b-SM期食管鳞癌的效果及安全性。 方法： 回顾性分析2015年1月至2019年12月东南大学附属中大医院收治的T1a-MM/T1b-SM期食管鳞癌71例患者，根据治疗方式将其分为两组：ESD组（单纯ESD治疗）和ESD-放疗组（ESD联合放疗），术后随访时间为（44±17）个月。采用生存分析比较两组患者无病生存率、总生存率的差异，并比较并发症的发生情况。对比两组患者基线资料，采用Cox比例风险回归模型分析无病生存率的影响因素。 结果： ESD-放疗组44例［男28例，女16例，年龄（65±7）岁］，ESD组27例［男18例，女9例，年龄（67±9）岁］。生存分析结果显示，ESD-放疗组1、3和5年的无病生存率分别为95.5%、92.9%和77.4%，均高于ESD组的85.2%、73.2%和62.7%（均P<0.05）。ESD-放疗组1、3和5年总生存率分别为100%、94.7%和94.7%，ESD组分别为96.3%、96.3%和79.4%，差异均无统计学意义（均P>0.05）。Cox比例风险回归模型分析显示，ESD联合放疗（HR=0.19，95%CI：0.04~0.90，P=0.037）、肿瘤完全切除（HR=0.25，95%CI：0.07~0.86，P=0.027）以及脉管侵犯（HR=12.06，95%CI：1.61~90.26，P=0.015）是无病生存率的影响因素。ESD最常见的并发症是食管狭窄，联合放疗后未出现3级及以上放疗不良反应。 结论： ESD联合放疗是T1a-MM/T1b-SM期食管鳞癌患者一种有效且安全的治疗策略。.