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Clinical outcomes of early gastric cancer with non-curative resection after pathological evaluation based on the expanded criteria


Autoři: Hyun Ju Kim aff001;  Sang Gyun Kim aff001;  Jung Kim aff001;  Hyoungju Hong aff001;  Hee Jong Lee aff001;  Min Seong Kim aff001;  Hyunsoo Chung aff001;  Hyun Chae Jung aff001
Působiště autorů: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea aff001;  Yonsei University Graduate School of Medicine, Seoul, Korea aff002;  Health Promotion Center, Seoul National University Hospital, Seoul, Korea aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0224614

Souhrn

Additional surgical resection should be considered for the patients with pathological findings beyond the expanded criteria with the risk for LN metastasis. However, close observation without additional surgery may be applied because of various reasons. We aimed to determine the clinical outcomes of early gastric cancer beyond the expanded criteria after endoscopic resection according to the pathological extent. A total of 288 patients with 289 lesions beyond the expanded criteria of endoscopic submucosal dissection for early gastric cancer were analyzed between 2005 and 2016, and classified into two groups according to additional treatment: observation (n = 175 patients, 175 lesions) and surgery (n = 113 patients, 114 lesions). The depth of tumor invasion was greater and the tumor-positive vertical margin and lymphatic and venous invasion were more common in the surgery group than in the observation group (P<0.001). Residual, synchronous, and metachronous tumors were more common in the observation group; however, the occurrence of regional lymph node and distant metastasis did not differ between the groups. Overall survival and 5-year disease-specific survival did not differ between the groups (observation vs surgery, 88.6 vs 93.8%; P = 0.259, 98.2 vs 100%; P = 0.484, respectively), but the 5-year disease-free survival was lower in the observation group (73.5 vs 97.9%; P<0.001). On multivariate analysis, tumor-positive lateral margin was a risk factor for residual tumor and lymphatic and venous invasion were risk factors for regional lymph node metastasis. In conclusion, the clinical course of beyond the expanded criteria of endoscopic submucosal dissection for early gastric cancer showed good prognosis over 98% in 5-year disease specific survival. If additional surgery cannot be performed, a close follow-up with endoscopy and abdominal computed tomography can be considered as an alternative for carefully selected patients without lymphatic and vascular invasion.

Klíčová slova:

Cancer risk factors – Gastric cancer – Lesions – Metastasis – Surgical and invasive medical procedures – Surgical oncology – Vascular surgery – Surgical pathology


Zdroje

1. Jung KW, Won YJ, Oh CM, Kong HJ, Lee DH, Lee KH, et al. Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2014. Cancer research and treatment: official journal of Korean Cancer Association. 2017;49(2):292–305. doi: 10.4143/crt.2017.118 28279062; PubMed Central PMCID: PMC5398380.

2. Cho KB, Jeon WJ, Kim JJ. Worldwide experiences of endoscopic submucosal dissection: not just Eastern acrobatics. World journal of gastroenterology. 2011;17(21):2611–7. doi: 10.3748/wjg.v17.i21.2611 21677828; PubMed Central PMCID: PMC3110922.

3. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2000;3(4):219–25. 11984739.

4. Ono H, Yao K, Fujishiro M, Oda I, Nimura S, Yahagi N, et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Digestive endoscopy: official journal of the Japan Gastroenterological Endoscopy Society. 2016;28(1):3–15. doi: 10.1111/den.12518 26234303.

5. Choi J, Kim SG, Im JP, Kim JS, Jung HC. Long-term clinical outcomes of endoscopic resection for early gastric cancer. Surgical endoscopy. 2015;29(5):1223–30. doi: 10.1007/s00464-014-3800-7 25159644.

6. Kang MS, Hong SJ, Kim DY, Han JP, Choi MH, Kim HK, et al. Long-term outcome after endoscopic submucosal dissection for early gastric cancer: focusing on a group beyond the expanded indication. Journal of digestive diseases. 2015;16(1):7–13. doi: 10.1111/1751-2980.12208 25366382.

7. Sohn SH, Lee SH, Kim KO, Jang BI, Kim TN. Therapeutic outcomes of endoscopic submucosal dissection for early gastric cancer: single-center study. European journal of gastroenterology & hepatology. 2017;29(1):61–7. doi: 10.1097/MEG.0000000000000718 27508325.

8. Kosaka T, Endo M, Toya Y, Abiko Y, Kudara N, Inomata M, et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center retrospective study. Digestive endoscopy: official journal of the Japan Gastroenterological Endoscopy Society. 2014;26(2):183–91. doi: 10.1111/den.12099 23560494.

9. Hatta W, Gotoda T, Oyama T, Kawata N, Takahashi A, Yoshifuku Y, et al. Is radical surgery necessary in all patients who do not meet the curative criteria for endoscopic submucosal dissection in early gastric cancer? A multi-center retrospective study in Japan. Journal of gastroenterology. 2017;52(2):175–84. doi: 10.1007/s00535-016-1210-4 27098174.

10. Hatta W, Gotoda T, Oyama T, Kawata N, Takahashi A, Yoshifuku Y, et al. Is the eCura system useful for selecting patients who require radical surgery after noncurative endoscopic submucosal dissection for early gastric cancer? A comparative study. Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2017. doi: 10.1007/s10120-017-0769-7 28983696.

11. Ito H, Gotoda T, Oyama T, Kawata N, Takahashi A, Yoshifuku Y, et al. Long-term oncological outcomes of submucosal manipulation during non-curative endoscopic submucosal dissection for submucosal invasive gastric cancer: a multicenter retrospective study in Japan. Surgical endoscopy. 2018;32(1):196–203. doi: 10.1007/s00464-017-5659-x 28639037.

12. Hatta W, Gotoda T, Oyama T, Kawata N, Takahashi A, Yoshifuku Y, et al. A Scoring System to Stratify Curability after Endoscopic Submucosal Dissection for Early Gastric Cancer: "eCura system". The American journal of gastroenterology. 2017;112(6):874–81. doi: 10.1038/ajg.2017.95 28397873.

13. Suzuki S, Gotoda T, Hatta W, Oyama T, Kawata N, Takahashi A, et al. Survival Benefit of Additional Surgery After Non-curative Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score Matching Analysis. Annals of surgical oncology. 2017;24(11):3353–60. doi: 10.1245/s10434-017-6039-4 28795364.

14. Park JY, Kim SG, Kim J, Han SJ, Oh S, Choi JM, et al. Risk factors for early metachronous tumor development after endoscopic resection for early gastric cancer. PloS one. 2017;12(9):e0185501. doi: 10.1371/journal.pone.0185501 28950014; PubMed Central PMCID: PMC5614623.

15. Japanese classification of gastric carcinoma: 3rd English edition. Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2011;14(2):101–12. Epub 2011/05/17. doi: 10.1007/s10120-011-0041-5 21573743.

16. Soetikno R, Kaltenbach T, Yeh R, Gotoda T. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2005;23(20):4490–8. doi: 10.1200/JCO.2005.19.935 16002839.

17. Abe N, Sugiyama M, Masaki T, Ueki H, Yanagida O, Mori T, et al. Predictive factors for lymph node metastasis of differentiated submucosally invasive gastric cancer. Gastrointestinal endoscopy. 2004;60(2):242–5. Epub 2004/07/28. doi: 10.1016/s0016-5107(04)01682-7 15278052.

18. Yokota T, Ishiyama S, Saito T, Teshima S, Narushima Y, Murata K, et al. Lymph node metastasis as a significant prognostic factor in gastric cancer: a multiple logistic regression analysis. Scandinavian journal of gastroenterology. 2004;39(4):380–4. Epub 2004/05/06. doi: 10.1080/00365520310008629 15125471.

19. Jang MY, Cho JW, Oh WG, Ko SJ, Han SH, Baek HK, et al. Clinicopathological characteristics of synchronous and metachronous gastric neoplasms after endoscopic submucosal dissection. The Korean journal of internal medicine. 2013;28(6):687–93. doi: 10.3904/kjim.2013.28.6.687 PMC3846994. 24307844

20. Lim JH, Kim SG, Choi J, Im JP, Kim JS, Jung HC. Risk factors for synchronous or metachronous tumor development after endoscopic resection of gastric neoplasms. Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2015;18(4):817–23. doi: 10.1007/s10120-014-0438-z 25326338.

21. Seo JH, Park JC, Kim YJ, Shin SK, Lee YC, Lee SK. Undifferentiated histology after endoscopic resection may predict synchronous and metachronous occurrence of early gastric cancer. Digestion. 2010;81(1):35–42. Epub 2009/12/24. doi: 10.1159/000235921 20029207.


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