Efficacy of endoscopic treatment on patients with severe dysplasia/carcinoma in situ of esophageal squamous cell carcinoma: A prospective cohort study

Abstract

Objective To explore the natural history of severe dysplasia/carcinoma in situ (SD/CIS) patients and to evaluate the efficacy of endoscopic treatment to SD/CIS patients. Methods Between January 2005 and December 2009, a population-based prospective screening program on esophageal squamous cell carcinoma (ESCC) was performed in Linzhou, China, with endoscopic screening plus iodine staining. All the eligible histologically confirmed SD/CIS patients were followed up through the door-to-door follow-up and local cancer registry. The endpoint was diagnosed as ESCC or the December 31st, 2016. Kaplan-Meier survival analysis and Log-rank test were used to compare the survival rates among treated and untreated patients. Results A total of 175 SD/CIS patients were enrolled and grouped by whether they received endoscopic treatment. Eleven-year cumulative incidence rates for untreated and treated SD/CIS patients were 10.7% [95% confidence interval (95% CI): 6.9−16.1] and 3.2% (95% CI: 1.4−7.0), respectively. The ESCC incidence free survival rate, and all-cause incidence and mortality free survival rates were all significantly higher in the treated patients vs. untreated patients (P=0.043, P=0.008 and P=0.015, respectively). The ESCC mortality free survival rate showed no significant differences between the two groups (P=0.847). Conclusions The cumulative incidence rate of SD/CIS patients to ESCC was much lower than previously reported. The Kaplan-Meier survival analysis showed that endoscopic treatment could increase the ESCC and all-cause disease-free survival rates of SD/CIS patients significantly.

Esophageal cancer: trends in incidence and mortality in China from 2005 to 2015

“…This is currently the best early screening method. 17 The central government expanded the scope of subsidies to local public health funds in 2005, including the screening, early diagnosis and treatment of esophageal cancer implemented in 2006. 18 The tumor stage at diagnosis was associated with the prognosis of esophagus cancer, and early detection could effectively reduce its mortality.…”

Long‐term effectiveness of one‐time endoscopic screening for esophageal cancer: A community‐based study in rural China

“…For patients with SD/CIS, 1 study pointed out that approximately 75% of those with untreated SD/CIS progressed to ESCC after 13 years of follow‐up, and endoscopic treatment was necessary for the majority of such patients, 5 which may induce overtreatment issues. However, another study reported a progression rate of only 10.7% for patients with untreated SD/CIS and 3.2% for those who were treated after an 11‐year follow‐up 20 . The results seem to be quite different, and it is difficult to tell which is more accurate at this moment.…”

“…The occurrence and development characteristics of ESCC provide opportunities for screening. Almost all grades of squamous dysplasia and CIS are strongly associated with an increased risk of ESCC and can be used as an intermediate endpoint for screening 15,20 . Significant improvements in survival can be seen when the disease is confined to the superficial mucosa, and the progression to cancer can be stopped if treatments are given before invasion 21,22 .…”

Methylated DNA Markers of Esophageal Squamous Cancer and Dysplasia: An International Study

“…Longitudinal studies have shown increasing risks of progression in those with mild-, moderate-and severe dysplasia (7,8). Successful endoscopic treatment of dysplasia has been demonstrated in recent studies (9)(10)(11)(12), opening the possibility of preventing ESCC by finding and treating severe dysplasia in high-risk individuals.…”