Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2024; 16(2): 72-82
Published online Feb 16, 2024. doi: 10.4253/wjge.v16.i2.72
Comparative efficacy and safety between endoscopic submucosal dissection, surgery and definitive chemoradiotherapy in patients with cT1N0M0 esophageal cancer
Shu-Ai Luo, Yu-Ying Sun, Ya-Ting Zeng, Chun-Yu Huang
Shu-Ai Luo, Yu-Ying Sun, Ya-Ting Zeng, Chun-Yu Huang, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Co-first authors: Shu-Ai Luo and Yu-Ying Sun.
Author contributions: Huang CY designed and performed the research and supervised the report; Luo SA performed the research, collected the data, wrote the paper and contributed to the analysis; Sun YY supervised the report, wrote the paper and revised the paper; Zeng YT contributed to the analysis and provided clinical advice. Luo SA and Sun YY have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper.
Supported by the Guangdong Esophageal Cancer Institute Science and Technology Program, No. M202013; and Guangdong Medical Research Foundation, No. A2021369.
Institutional review board statement: All procedures in studies involving human participants were carried out in accordance with ethical standards and approved by the Ethics Committee (No. SL-B2023-032-01).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. For full disclosure, the details of the study are published on the home page of Sun Yat-sen University Cancer Center.
Conflict-of-interest statement: The authors declare that they have no financial relationships to disclose.
Data sharing statement: The raw data used to support the findings of this study could be obtained by getting in touch with the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Chun-Yu Huang, MD, PhD, Professor, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou 510060, Guangdong Province, China.
Received: November 22, 2023
Peer-review started: November 22, 2023
First decision: November 30, 2023
Revised: December 19, 2023
Accepted: December 25, 2023
Article in press: December 25, 2023
Published online: February 16, 2024
Research background

For cT1N0M0 esophageal cancer (EC), the current study has mainly focused on surgery and endoscopic submucosal dissection (ESD), while definitive chemoradiotherapy (d-CRT) is a complementary treatment for cT1N0M0 EC. Studies on estimating the therapeutic effect and safety of d-CRT, surgery and ESD are not sufficient, so this study is important.

Research motivation

Early-stage EC is currently increasing year by year, and its treatment methods are also changing rapidly. It is very important to choose the treatment methods with good prognosis and fewer complications, while some patients have the dilemma of treatment choice due to age, cost and other reasons. It is very important to summarize and compare the advantages and disadvantages of the existing treatment methods, which is very important for the health management of patients with EC.

Research objectives

By comparing the efficiency and safety of ESD, surgery and d-CRT for cT1N0M0 EC, to provide a clinical basis for the treatment selection of cT1N0M0 EC and to achieve better prognosis and quality of survival for EC.

Research methods

We retrospectively analyzed the medical records, pathology, imaging and endoscopic findings, and follow-up results of the cT1N0M0 EC. We met the inclusion criteria and adjusted the effects of confounding factors using the inverse probability of treatment weighting method to conduct survival analysis, Cox proportional risk regression analysis, collected complications and costs, rescue measures after recurrence, and finally evaluated the efficacy and safety of cT1N0M0 EC patients receiving ESD, surgery and d-CRT.

Research results

Results showed that ESD had better survival outcomes, lower hospital costs and more acceptable occurrences of complications. This study provides a more comprehensive analysis of the efficacy and safety of current cT1N0M0 EC treatment patterns and provides new evidence for the use of ESD in cT1N0M0 EC. To our knowledge, our study is the first to compare the effects of all three treatments for cT1N0M0 EC. In addition, there are relatively few studies on d-CRT for cT1N0M0 EC patients, and our study can provide relevant evidence of d-CRT for cT1N0M0 EC, so it has a certain new innovation.

Research conclusions

This is a first retrospective study to compare overall survival, recurrence-free survival and complication rates of ESD, surgery and d-CRT, and show that ESD attained better survival benefits and lower hospitalization costs than surgery and d-CRT, and they had similar complication rates. This study provides a more comprehensive analysis of the efficacy and safety of current cT1N0M0 EC treatment patterns and provides new evidence for the use of ESD in cT1N0M0 EC.

Research perspectives

In the future, we will conduct a subgroup analysis of survival outcomes for the three therapies in cT1N0M0 EC patients, and investigate methods to reduce the occurrence of complications.