• Ga Hee Kim, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Kee Wook Jung, Kim Do Hoon DH https://orcid.org/0000-0002-4250-4683 Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seo, Kim Hyeong Ryul HR https://orcid.org/0000-0002-6691-7693 Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan C, Kee Don Choi, Ho June Song, Yong-Hee Kim, Gin Hyug Lee, Hwoon-Yong Jung, and Seung-Il Park.
• Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
• Gut Liver. 2021 Jan 19.

Background/AimsData regarding the prognosis of early esophageal cancer are lacking. This study investigated the long-term outcomes and factors affecting the survival of patients with mucosal esophageal squamous cell carcinoma (T1aESCC).MethodsWe analyzed the clinical and tumor-specific parameters of 263 patients who received surgical resection (SR; n=63) or endoscopic resection (ER; n=200) for T1aESCC. Underlying comorbidities were scored using the Charlson Comorbidity Index (CCI). Overall survival (OS) was the primary outcome, and multivariate regression analysis was performed to predict factors for OS.ResultsOf the study patients (age, 64.5±8.0 years), the CCI was 1.0±1.4 in the ER group and 0.6±0.9 in the SR group (p=0.107). The 5-year OS rate during follow-up (54.4±20.4 months) was 85.7% (ER group, 86.8%; SR group, 82.4%; p=0.631). The cumulative 5-year incidence of esophageal cancer recurrence was 10.5% in the ER group (vs 0% in the SR group). The overall mortality rate was 12.9% (12.0% in the ER group and 15.9% in the SR group; p=0.399). The most common cause of mortality was second primary cancers in the ER group (75%) and organ dysfunction or postoperative complications in the SR group (70%). According to multivariate analysis, only CCI was significantly associated with OS (p<0.001). The 5-year OS rate in patients with a CCI >2 and in those with a CCI ≤2 was 60.2% and 88.2%, respectively (p<0.001). The treatment method (ER vs SR) was not a significant affecting factor (p=0.238).ConclusionsThe long-term prognosis of patients with T1aESCC was significantly associated with underlying comorbidities.

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