Endoscopic Program With a Scoring System for Surveillance of Metachronous Esophageal Cell Carcinoma for Older Patients Considering Risk Factors

Background Endoscopic resection (ER) is a minimally invasive treatment method that allows curative resection and can help preserve esophageal function. There is 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 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. This study evaluated the association between the risk factors and prognosis for metachronous (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). The risk factors for overall survival (OS) were investigated using the American Society of Anesthesiologists (ASA)-Physical Status (PS) (ASA-PS) classification system and the Charlson Comorbidity Index (CCI). We analyzed factors associated with OS 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) <18.5 and CCI ≥ 2 were significant risk factors for OS in the multivariate analysis (p = 0.050 and p = 0.037). Multivariate analysis revealed that non-older, Lugol-voiding lesion (LVL)s (grade B/C) and HNC were significantly related to metachronous ESCC (p = 0.035, p = 0.035, and p = 0.014). In the development cohort, BMI, CCI, age, LVLs, and HNC 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. The OS was significantly lower in the high-score group than the low-score group (p = 0.012). Conclusion We proposed an endoscopic surveillance scoring system for metachronous ESCC considering BMI and CCI in older patients.