食道扁平上皮癌に対する内視鏡治療非治癒切除患者の現状と生命予後を考えた治療戦略

Patients with noncurative endoscopic resection (ER) (pT1a-MM/pT1b-SM) for esophageal squamous cell carcinoma (ESCC) have a certain risk of lymph node metastasis (LNM). Although the definite treatment strategy after ER is not recommended for pT1a-MM with negative lymphovascular invasion (LVI) because of its relatively low LNM risk, no additional treatment was selected in ＞ 90% of such patients in clinical practice. Conversely, additional treatment (esophagectomy or chemoradiotherapy) is recommended for pT1a-MM with positive LVI or pT1b-SM. Recently, risk stratification for metastatic recurrence in patients without additional treatment after noncurative ER for ESCC was established, and the efficacy of a novel treatment strategy, ER and selective chemoradiotherapy, for cT1bN0M0 ESCC was confirmed. Since many patients died of diseases other than ESCC, several studies focused on clinical prognostic factors, as well as pathological factors. Eventually, establishing a novel algorithm for treatment strategy of older patients with noncurative ER and developing a novel biomarker for predicting LNM or metastatic recurrence after noncurative ER will be anticipated in the field of ESCC.