Long-term outcomes of additional surgical versus nonsurgical treatment after non-curative endoscopic resection for T1 superficial esophageal cancer
Bibliographic record
Abstract
BACKGROUND: Endoscopic resection (ER) is the main treatment for T1 superficial esophageal cancer (SEC). Additional surgical resection (ASR) is recommended to improve the prognosis of patients with non-curative resection who are at high risk of recurrence and metastasis. However, the survival benefit of ASR compared to non-ASR remains unclear. We conducted a systematic review and meta-analysis to quantify the survival benefits of ASR versus non-ASR, providing robust data for clinical decision-making. METHOD: We searched PubMed, Cochrane, Embase, and Web of Science databases for studies published before 24 February 2025. The primary outcome was overall survival (OS), recurrence-free survival (RFS), and disease-specific survival (DSS). Two independent reviewers screened and extracted the data and resolved disagreements by consensus. Risk of bias was assessed with Newcastle-Ottawa Scale. RESULTS: The review identified 15 retrospective studies involving 1348 patients. Analysis showed that patients with ASR had significant survival advantages over non-ASR patients in OS, RFS, and DSS. Hazard ratios (HRs) with 95% confidence intervals (CIs) were as follows: OS (HR = 3.06; 95% CI: 2.11-4.43), RFS (HR = 1.68; 95% CI: 1.16-2.41), and DSS (HR = 4.11; 95% CI: 1.64-10.28). Survival curves indicated that at 3, 5, and 10 years, the OS rates were 95.9% versus 88.0%, 91.4% versus 78.2%, and 86.7% versus 56.9% for the ASR and non-ASR groups, respectively. Similarly, the RFS rates were 93.4% versus 82.9%, 83.6% versus 73.8%, and 74.5% versus 57.5%. For DSS, the rates were 98.4% versus 94.5%, 97.8% versus 91.1%, and 97.8% versus 87.9%. Log-rank tests confirmed significance for all comparisons except 10-year DSS. CONCLUSIONS: For patients with T1 SEC who had non-curative ER, ASR therapy provides advantages over non-ASR therapy. However, within 5 years, the DSS difference between the ASR and non-ASR groups is likely to be minimal, with a range of approximately 4-6%.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.023 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.007 | 0.015 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".