Endoscopic program with a scoring system for surveillance of metachronous esophageal cell carcinoma for older patients considering risk factors after endoscopic resection

Sep 21, 2026

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Evaluates how risk factors relate to prognosis for metachronous esophageal squamous cell carcinoma (ESCC) after endoscopic resection in older patients. A retrospective observational cohort of 127 ESCC patients treated from 2015 to 2020 was stratified as non-older (≤64), early older (65–74), and late older (≥75). Multivariate Cox regression identified factors for poor overall survival and metachronous ESCC, and a surveillance scoring system was developed and validated.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Introduction

Methods

Patients and study design

LVL grades

Follow-up endoscopic examinations post-ER

Definition of synchronous and metachronous ESCC

Statistical analysis

Esophagus (2024) 21:530–538 [https://doi.org/10.1007/s10388-024-01077-5](https://doi.org/10.1007/s10388-024-01077-5) Endoscopic program with a scoring system for surveillance of metachronous esophageal cell carcinoma for older patients considering risk factors after endoscopic resection Sakiko Naito1 · Masakatsu Fukuzawa1 · Hirokazu Shinohara1 · Yasuyuki Kagawa1 · Akira Madarame1 · Yohei Koyama1 · Hayato Yamaguchi1 · Yoshiya Yamauchi1 · Takao Itoi1 Received: 31 October 2023 / Accepted: 29 July 2024 / Published online: 9 August 2024 © The Author(s) 2024 Abstract Background This study evaluated the association between the risk factors and prognosis for metachronous esophageal squamous cell carcinoma (ESCC) after endoscopic resection (ER) of esophageal cancer in older patients. Methods We conducted a retrospective observational study of 127 patients with ESCC who underwent ER from 2015 to 2020. Patients were classified as non-older (≤ 64 years), early older (65–74 years), and late older (≥ 75 years) . We analyzed factors associated with poor overall survival and metachronous ESCC after ER using multivariate Cox regression analysis. A metachronous ESCC prediction scoring system was examined to validate the surveillance endoscopy program. Results Body mass index (BMI) and Charlson Comorbidity Index (CCI) were significant risk factors for poor overall survival in the multivariate analysis (p = 0.050 and p = 0.037, respectively) . Multivariate analysis revealed that age of < 64 years, Lugol-voiding lesions (grade B/C), and head and neck cancer were significantly related to metachronous ESCC (p = 0.035, p = 0.035, and p = 0.014, respectively) . In the development cohort, BMI < 18.5 kg/m2, CCI >2, age < 64 years, Lugol-voiding lesions (grade B/C), and head and neck cancer were significantly related to metachronous ESCC, and each case was assigned 1 point. Patients were classified into low (0, 1, and 2) and high (> 3) score groups based on total scores. According to Kaplan–Meier curves, the 3-year overall survival was significantly lower in the high-score group than in the low-score group (91.5% vs. 100%, p = 0.012) . Conclusions We proposed an endoscopic surveillance scoring system for metachronous ESCC considering BMI and CCI in older patients. Keywords Older patients · Endoscopic resection · Metachronous esophageal squamous cell carcinoma · Surveillance Introduction Esophageal cancer is the eighth most common disease worldwide and has the sixth highest mortality rate. Further, this disease causes approximately 3.2% of all cancer-related deaths [1–4] . Endoscopic resection (ER) is a minimally invasive treatment method that allows for curative resection and can help preserve esophageal function [5] . Therefore, early diagnosis and prompt treatment are important for * Sakiko Naito [rin.sooooo.sweety@gmail.com](rin.sooooo.sweety@gmail.com) 1 Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 167 0043, Japan the management of this disease. In 2009, the World Health Organization (WHO) identified alcohol-associated acetaldehyde as a group 1 carcinogen [6] . Alcohol consumption is associated with the risk of damage to the esophageal mucosa. Specific risk factors include the amount of alcohol intake, alcohol consumption duration, and alcohol metabolism-related genotypes persisting in the esophageal mucosa [7–9] . Katada et al. [10] reported a relationship between alcohol consumption and the degree of esophageal mucosal damage in head and neck cancer (HNC) associated with field cancerization, as well as between esophageal mucosal damage grade and the risk of developing metachronous esophageal squamous cell carcinoma (ESCC) and HNC. With the advent of a super-aging society, medical care for older adults has become a major social issue. Frailty is associated with decreased quality of life and post-treatment effects among older adult patients, who are l

FAQs

Which factors were significant for poor overall survival after endoscopic resection?

In multivariate analysis, BMI and the Charlson Comorbidity Index (CCI) were significant risk factors for poor overall survival.

How were patients scored for metachronous ESCC surveillance?

In the development cohort, BMI < 18.5 kg/m2, CCI > 2, age < 64 years, Lugol-voiding lesions (grade B/C), and head and neck cancer were each assigned 1 point, producing low (0–2) and high (>3) score groups.

How did the surveillance scoring groups differ in survival outcomes?

Kaplan–Meier analysis showed the 3-year overall survival was significantly lower in the high-score group than in the low-score group (91.5% vs. 100%).

Sep 21, 2026

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