Clinical Outcomes and Prognostic Factors in Patients Undergoing Salvage Endoscopic Therapy for cT1N0M0 Local Failure After Chemoradiotherapy for Esophageal Cancer: A Multicenter Retrospective Study.

Abstract

Objectives: Salvage endoscopic therapy is increasingly recommended for localized, superficial failure at the primary site after chemoradiotherapy for esophageal squamous cell carcinoma. This multicenter retrospective study aimed to evaluate the clinical outcomes and prognostic factors associated with overall survival in patients who underwent salvage endoscopic therapy for cT1N0M0 local failure after chemoradiotherapy or radiotherapy for esophageal squamous cell carcinoma.

Methods: We retrospectively analyzed patients with cT1N0M0 local failure after chemoradiotherapy or radiotherapy who underwent endoscopic resection or photodynamic therapy using talaporfin sodium at two Japanese institutions between 2012 and 2021. Clinical outcomes and prognostic factors for overall survival were assessed using multivariate analysis.

Results: Complete resection was achieved in 63 of 84 patients (75%) who underwent endoscopic resection, and a local complete response was achieved in 50 of 81 patients (62%) who underwent photodynamic therapy. During a median follow-up of 34 months (range, 2-109 months), 3-year overall survival, disease-specific survival, local recurrence-free survival, and esophagectomy-free survival rates were 79%, 88%, 54%, and 79%, respectively. A high Charlson Comorbidity Index (≥ 3; hazard ratio: 3.3) was significantly associated with poor overall survival (3-year overall survival rate: 64%), although the 3-year disease-specific survival in this group remained high at 94%.

Conclusions: We clarified the clinical outcomes and prognosis of salvage endoscopic therapy for cT1 local failure. The Charlson Comorbidity Index may serve as a useful prognostic factor to aid in clinical decision-making.