Location characteristics of superficial esophageal squamous cell carcinoma

The location-specific characteristics of superficial esophageal squamous cell carcinoma (ESCC) have not been determined. This study analyzed the locational characteristics of superficial ESCC. Medical records of patients with superficial ESCC treated between December 2008 and November 2024 at Pusan National University Yangsan Hospital were retrospectively reviewed. ESCC locations and final pathological results confirmed by surgery or endoscopic resection were compared. A total of 150 patients with 163 superficial ESCCs were analyzed. Lesions were located in in the upper thoracic (n = 16, 9.8%), mid-thoracic (n = 104, 63.8%), and lower thoracic regions (n = 43, 26.4%). Although upper thoracic lesions had higher deep submucosal cancer (62.5% vs. 29.8%, p = 0.015) and poorly differentiated carcinoma (37.4% vs. 9.6%, p = 0.005) rates than mid-thoracic lesions, no lymph node metastasis or lympho-vascular invasion was detected. In contrast, the deep submucosal cancer rate was less for lower thoracic lesions than mid-thoracic lesions (14.0% vs. 29.8%, p = 0.049), but lymph node metastasis (7.0% vs. 5.8%, p = 0.782) and lympho-vascular invasion (7.0% vs. 4.8%, p = 0.600) rates tended to be higher. Superficial ESCCs in the upper thoracic region had more features requiring surgery but had less lymph node metastasis or lympho-vascular invasion, whereas lesions in the lower thoracic region showed the opposite trend. The results of our study may be helpful when deciding between surgery and endoscopic resection for some patients with superficial ESCC.