Choi Moon Han, Hong Su Jin, Han Jae Pil, Song Jeong-Yeop, Kim Dae Yong, Seo Sung Woo, Ha Ji Su, Lee Yun Nah, Ko Bong Min, Lee Moon Sung
Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon 420-767, Korea.
Korean J Gastroenterol. 2013 Apr;61(4):196-202. doi: 10.4166/kjg.2013.61.4.196.
BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment of early gastric cancer (EGC). However, the indication of ESD in undifferentiated-type EGC was controversial. The aim of this study was to evaluate the therapeutic outcomes of ESD in undifferentiated-type EGC according to expanded indication.
At Soonchunhyang University Bucheon Hospital, a total of 82 lesions in 81 patients with undifferentiated-type EGC were treated with ESD. The therapeutic outcomes of ESD were evaluated by resection method (en bloc resection; piecemeal resection), histologic curative resection, complications and recurrence rates after ESD.
The rate on en bloc resection and complete resection rate were 87.8% (72/82) and 80.5% (66/82), respectively. In signet ring cell carcinoma, the complete resection rate was higher than those in poorly differentiated adenocarcinoma and poorly differentiated adenocarcinoma with signet ring cell features, but there was no statistical significance (89.3% vs. 75.0%, 76.7%; p=0.347). The lateral margin positivity rate in poorly differentiated adenocarcinoma, signet ring cell carcinoma and poorly differentiated adenocarcinoma with signet ring cell features were 12.5%, 3.6% and 13.3%, respectively (p=0.395). The vertical margin positivity rate were 12.5%, 3.6% and 10.0%, respectively (p=0.485). The overall recurrence rate was 3.0% during a mean follow-up period of 37.4 months.
ESD may be considered as a feasible treatment for undifferentiated-type EGC according to expanded indication. The therapeutic outcome of ESD in undifferentiated-type EGC is likely to be favorable, though further longer follow-up studies are needed.
背景/目的：内镜黏膜下剥离术（ESD）已被公认为早期胃癌（EGC）的标准治疗方法。然而，未分化型EGC中ESD的适应证存在争议。本研究的目的是根据扩大的适应证评估ESD治疗未分化型EGC的疗效。
在顺天乡大学富川医院，对81例未分化型EGC患者的82个病变进行了ESD治疗。通过切除方法（整块切除；分片切除）、组织学根治性切除、ESD术后并发症和复发率来评估ESD的治疗效果。
整块切除率和完整切除率分别为87.8%（72/82）和80.5%（66/82）。在印戒细胞癌中，完整切除率高于低分化腺癌和具有印戒细胞特征的低分化腺癌，但差异无统计学意义（89.3%对75.0%，76.7%；p = 0.347）。低分化腺癌、印戒细胞癌和具有印戒细胞特征的低分化腺癌的侧切缘阳性率分别为12.5%、3.6%和13.3%（p = 0.395）。垂直切缘阳性率分别为12.5%、3.6%和10.0%（p = 0.485）。在平均37.4个月的随访期内，总复发率为3.0%。
根据扩大的适应证，ESD可被视为未分化型EGC的一种可行治疗方法。未分化型EGC中ESD的治疗效果可能良好，不过还需要进一步的长期随访研究。
