Direct gastric invasion predicts poor prognosis in esophageal squamous cell carcinoma

Background Esophageal squamous cell carcinoma (ESCC) with direct gastric invasion is uncommon and is rarely discussed in previous literature. This study aims to investigate the clinicopathological features of these patients and compare prognosis across different treatment modalities. Methods From 2011 to 2020, 398 patients with ESCC were enrolled for analysis, excluding those with dual cancers. Demographic characteristics and clinicopathologic data were collected through medical records and questionnaires. Results Twenty-three patients exhibited direct gastric invasion by ESCC at initial diagnosis. Most were diagnosed at advanced stages, with 95% having regional lymph node metastases and 26% having distant metastases. The median overall survival was 10.6 months post-diagnosis. Performance status and treatment modalities were independent prognostic factors. Patients receiving chemoradiotherapy followed by surgery demonstrated the best survival outcomes compared to those receiving chemoradiotherapy alone or best supportive care. In ESCC patients with tumor involving lower-third esophagus, gastric invasion was associated with significantly poorer prognosis. Two-year overall survival rates were 9.7% for patients with gastric invasion versus 44.1% for those without. Multivariate Cox regression analysis demonstrated that gastric invasion as an independent predictor of poor prognosis in patients with lower-third esophageal ESCC (hazard ratio = 2.2, p = 0.01). Conclusions In ESCC patients with tumor involving lower-third esophagus, gastric invasion was associated with poor prognosis. However, chemoradiotherapy followed by surgery may confer a survival advantage in eligible patients.