Department of Medicine and Molecular Science, Hiroshima University Graduate School of Biomedical Science, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan.
Gastric Cancer. 2012 Jan;15(1):97-105. doi: 10.1007/s10120-011-0076-7. Epub 2011 Jul 23.
The 2010 Japanese Gastric Cancer Association guidelines for the treatment of submucosal invasive gastric cancer (SM-GC) specify size 30 mm or less, differentiated-dominant histology, lack of vessel involvement, and submucosal invasion of less than 500 μm (SM1) as expanded criteria for curative endoscopic resection. Our purpose in this study was to confirm the validity of the expanded indications for curative endoscopic submucosal dissection (ESD) of SM-GC.
The study subjects were 173 patients with SM-GC resected by ESD at Hiroshima University Hospital between April 2002 and September 2010, including 99 patients for whom 3-plus years' follow-up information was available. Post-ESD outcomes were compared between cases of SM1-GC that met the expanded ESD criteria, those that did not, and SM2-GC cases.
Complete resection was achieved for 93.2% of the SM1-GCs that met the expanded criteria. There was neither metastasis to lymph nodes or other organs nor local recurrence among the SM1-GCs. Disease-specific survival did not differ significantly between patients that were simply followed up after ESD and those that were treated by additional surgical resection.
Our outcome data support the clinical validity of ESD without additional surgical resection for SM1-GCs that meet the expanded criteria.
2010 年日本胃癌协会制定的黏膜下浸润性胃癌（SM-GC）治疗指南规定，将直径 30mm 或以下、分化优势型组织学、无血管侵犯和黏膜下浸润小于 500μm（SM1）作为扩大内镜下黏膜下剥离术（ESD）治愈性切除的适应证标准。本研究旨在验证将这些标准扩大应用于治疗 SM-GC 的有效性。
本研究纳入了 2002 年 4 月至 2010 年 9 月在广岛大学医院接受 ESD 治疗的 173 例 SM-GC 患者，其中 99 例患者可获得 3 年以上的随访信息。比较符合扩大 ESD 标准的 SM1-GC 患者、不符合标准的 SM1-GC 患者和 SM2-GC 患者的 ESD 后结局。
符合扩大标准的 SM1-GC 患者中，完全切除率为 93.2%。在这些患者中，未见淋巴结或其他器官转移或局部复发。单纯 ESD 后随访与 ESD 后追加外科手术治疗的患者之间，疾病特异性生存率无显著差异。
我们的研究结果支持对符合扩大标准的 SM1-GC 患者采用 ESD 治疗而无需追加外科手术的临床有效性。
