Endoscopic surveillance reduces incidence of esophageal cancer in at-risk patients
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Although individuals in China with low-grade intraepithelial neoplasia are at higher risk for developing esophageal squamous cell carcinoma, that risk can be reduced by more than 30% with surveillance endoscopy, according to research.
“Esophageal mild dysplasia or moderate dysplasia, namely, low-grade intraepithelial neoplasia (LGIN), is the precursor lesion for esophageal squamous cell carcinoma (ESCC) and patients with LGIN are recommended for endoscopic surveillance in the guidelines for ESCC screening and early detection and early treatment (EDET) in China,” He Li, MPH, of the Office of Cancer Screening at Chinese Academy of Medical Sciences and Peking Union Medical College, and colleagues wrote in JAMA Network Open. “The primary aim of endoscopic surveillance in patients with LGIN is to reduce new esophageal cancer (EC)-related cases and deaths by detecting and treating premalignant lesions and early-stage asymptomatic EC.
“The lack of solid evidence on surveillance endoscopy in patients with LGIN has limited the quality of evidence of surveillance endoscopy recommendations in the guidelines for ESCC screening and EDET in China.”
In a community-based, multicenter, prospective cohort study, Li and colleagues evaluated 3,258 patients with LGIN (54.39% men; mean age, 58.21 years) diagnosed by endoscopic screening between July 2007 and December 2016. The primary outcome of interest was incidence of ESCC, obtained using the ESCC standardized ratio (SIR). Researchers compared incidence among patients who underwent at least one surveillance endoscopy (42.3%) vs. those who did not undergo any surveillance endoscopy (57.7%).
During a median follow-up of 7.96 years, 170 patients were diagnosed with ESCC (cumulative incidence = 6.28/1,000 person-years), and the incidence was higher among patients in the non-surveillance group compared with the surveillance group (113 cases; 7.07/1,000 person-years vs. 57 cases; 5.14/1,000 person-years).
In addition, researchers reported higher incidence rates among men, patients older than 50 years, those with a lower education level and those with a family history of EC.
Patients with LGIN in the surveillance group also had a lower SIR compared with those in the non-surveillance group (4.07; 95% CI, 1.13-10.34 vs. 5.65; 95% CI, 2-12.58), although patients in both groups had a higher risk for ESCC compared with the general population (SIR = 5; 95% CI, 1.62-11.67).
Further, surveillance endoscopy correlated with a 31% decreased risk for developing ESCC (HR = 0.69; 95% CI, 0.5-0.95).
“In this prospective cohort study of patients with LGIN, our findings support surveillance endoscopy for patients with LGIN, as they have a higher risk of developing ESCC than the general population. In addition, surveillance endoscopy in patients with LGIN is associated with a reduction in ESCC incidence,” Li and colleagues concluded. “In the future, we will continue to follow up the surveillance cohort and provide updates and key information, such as the tumor stages and treatment, detailed endoscopic images and survival rates.”
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