Risk factors for non-curative resection after endoscopic submucosal dissection for early esophageal lesions and analysis of secondary treatment efficacy.

OBJECTIVE

Endoscopic submucosal dissection (ESD) has become a first-line treatment for early esophageal cancer and precancerous lesions; however, non-curative resection (N-CR) occurs in a significant proportion of cases, necessitating additional surgical or chemoradiotherapy treatment. This study aimed to analyze the risk factors associated with N-CR following ESD and compare the efficacy of different secondary treatment strategies.

METHODS

We conducted a retrospective analysis of 306 patients who underwent ESD for early esophageal lesions at The Fourth Hospital of Hebei Medical University between January 2017 and December 2021. Patients were divided into curative resection (CR) and non-curative resection (N-CR) groups. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for N-CR. A predictive nomogram model was constructed using R software. For the 49 patients with N-CR, we compared recurrence rates at 3 months, 1 year, and 2 years among three treatment strategies: no additional treatment (n = 22), surgical resection (n = 17), and chemoradiotherapy (n = 10).

RESULTS

The overall N-CR rate was 16.0% (49/306). Multivariate analysis identified four independent risk factors for N-CR: gastroscopic pathology (OR = 0.186, 95% CI: 0.037-0.948, P = 0.043), depth of infiltration (OR = 0.012, 95% CI: 0.002-0.077, P < 0.001), lesion location (OR = 0.185, 95% CI: 0.038-0.890, P = 0.035), and gross morphological type (OR = 0.018, 95% CI: 0.002-0.209, P = 0.001). The nomogram demonstrated good predictive accuracy. The 2-year recurrence rates were 18.18% for the no-treatment group, 11.79% for the surgical group, and 10.00% for the chemoradiotherapy group. No significant differences in overall survival or disease-free survival were observed among the three groups (P > 0.05).

CONCLUSIONS

ESD is a safe and effective treatment for early esophageal lesions. Gastroscopic pathology, depth of infiltration, lesion location, and gross type are independent predictors of N-CR. The predictive nomogram can assist clinical decision-making. Both surgical resection and chemoradiotherapy provide effective secondary treatment options for N-CR cases, with comparable oncological outcomes.