Dynamic Changes in Inflammatory Cytokines and T-Lymphocyte Subsets after Endoscopic Submucosal Dissection for Early Gastrointestinal Cancer

Abstract

Background and Aims: This study aimed to characterize the dynamic changes in inflammation and T-lymphocyte subsets for early gastrointestinal cancer before and after endoscopic submucosal dissection (ESD) (pre-ESD; postoperative days 1, 7, and 30).

Methods: A total of 189 patients with early gastrointestinal cancer who underwent ESD and achieved en bloc resection were enrolled, including 53 cases of early esophageal cancer, 55 cases of early gastric cancer, and 81 cases of early colorectal cancer. Patients were categorized into a non-R0 en bloc resection group (n=32), a non-curative R0 resection group (n=62), and a curative resection group (n=95). Clinical characteristics, T-lymphocyte subsets, inflammatory markers, and postoperative complications were analyzed.

Results: ESD significantly ameliorated T-lymphocyte subsets and inflammatory cytokines, with the most pronounced improvement observed in the curative resection group. Pre- and post-ESD levels of these markers were significantly correlated with lesion size, tumor morphology, and depth of invasion. The non-R0 en bloc resection group had a markedly higher complication rate than the other groups, whereas the curative resection group showed the lowest rate. Improvements in immune and inflammatory indices after ESD did not differ significantly among early cancers of different sites. The postoperative complication incidence was not associated with tumor sites.

Conclusions: ESD markedly ameliorates the imbalance between T-lymphocyte subsets and inflammatory cytokine levels in early gastrointestinal cancer, with these indicators showing strong correlations with lesion size, tumor morphology, and depth of invasion. Curative resection demonstrates the greatest therapeutic benefit and the lowest postoperative complication rate.