[Comparative analysis of the efficacy between endoscopic submucosal dissection combined with low-dose radiotherapy and direct surgical resection for T1a-MM/T1b-SM stage esophageal squamous cell carcinoma].

Objective

To compare the efficacy between endoscopic submucosal dissection (ESD) combined with low-dose radiotherapy and direct surgical resection in patients with T1a-MM/T1b-SM stage esophageal squamous cell carcinoma.

Methods

A retrospective analysis was performed on the clinical data of 169 patients diagnosed with T1a-MM/T1b-SM stage esophageal squamous cell carcinoma at Zhongda Hospital Affiliated to Southeast University from January 1, 2016 to September 30, 2024. There were 124 males and 45 females, with the age of (65.9±7.9) years. According to different treatment regimens, the patients were divided into the ESD combined with low-dose radiotherapy group (n=58) and the direct surgical resection group (n=111). Propensity score matching (PSM) was used for 1∶2 matching with respect to lesion length, pathological grade and invasion depth. Follow-up was terminated at the time of patient death or September 30, 2024. The recurrence rate, mortality rate, complication rate and quality-of-life-related indicators were compared between the two groups after PSM.

Results

After PSM, a total of 40 patients were included, among whom 18 were in the ESD combined with low-dose radiotherapy group and 22 in the direct surgical resection group. After PSM, there were no statistically significant differences between the two groups in age, lesion length, lesion location, pathological grade, invasion depth, and resection margin status, (all P>0.05). The follow-up time was 36.00 (25.75, 41.50) months in the ESD combined with low-dose radiotherapy group and 37.00 (34.25, 48.25) months in the direct surgical resection group, respectively. One death occurred in the ESD combined with low-dose radiotherapy group (due to myocardial infarction), while no deaths occurred in the direct surgical resection group, with no statistically significant difference between the two groups (P=0.450). Three recurrences were observed in the ESD combined with low-dose radiotherapy group, whereas no recurrences occurred in the direct surgical resection group, with no statistically significant difference between the two groups (P=0.083). The common complication was esophageal stenosis (2 cases in the ESD combined with low-dose radiotherapy group and 1 case in the direct surgical resection group). Complications in the ESD combined with low-dose radiotherapy group were mainly radiotherapy-related, including myelosuppression (4 cases), radiation esophagitis (3 cases), and radiation pneumonitis (2 cases).Complications in the direct surgical resection group mainly included pulmonary infection (4 cases) and anastomotic leakage (1 case). There was no statistically significant difference in the overall complication rate between the two groups (P=0.072). The postoperative pain score was lower in the ESD combined with low-dose radiotherapy group than in the direct surgical resection group [(1.17±1.04) vs (2.09±0.81) points, P=0.004]. However, there were no statistically significant differences in nutritional status or physical performance score between the two groups (all P>0.05). The ESD combined with low-dose radiotherapy group was superior to the direct surgical resection group in all 6 core quality-of-life dimensions: physical function, role physical, bodily pain, general health, vitality, and social functioning(all P<0.05). There were no statistically significant differences in role emotional or mental health between the two groups (all P>0.05).

Conclusions

For patients with T1a-MM/T1b-SM stage esophageal squamous cell carcinoma who have some choose and high-risk factors, ESD combined with low-dose radiotherapy exhibits short-term tumor-control efficacy comparable to that of direct surgical resection. Meanwhile, it demonstrates greater advantages in preserving esophageal function, degree of complications, alleviating postoperative pain and quality of life.