Choi Jeongmin, Kim Sang Gyun, Im Jong Pil, Kim Joo Sung, Jung Hyun Chae
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Yongun-dong 28, Chongno-gu, Seoul, 110-744, South Korea,
Surg Endosc. 2015 May;29(5):1223-30. doi: 10.1007/s00464-014-3800-7. Epub 2014 Aug 27.
We aimed to evaluate long-term clinical outcomes of endoscopic resection for early gastric cancer (EGC).
From 2005 through 2011, 961 patients with EGC were treated with endoscopic submucosal dissection (ESD). Patients were grouped as standard and expanded criteria, while those who did not meet the expanded criteria were regarded as the group beyond the expanded criteria. Complete resection rate and the long-term clinical outcomes were compared among the three groups.
Complete resection rate was significantly higher in the standard group than in expanded and beyond the expanded group; 96.1% for standard, 92.5% for expanded, 55.5% for beyond the expanded indication group. During a mean follow-up of 42 months, local tumor recurrence developed more frequently in beyond the expanded group (7.8%) than in the standard and expanded group (1.8%). Metachronous cancer incidence (6.5%) did not differ significantly between the three groups. Two-thirds of recurred or metachronous tumors were treated with additional ESD. Lymph node metastasis developed in 0.6%. Five-year overall survival rate was 94.8% (96.6% for standard, 94.2% for expanded, 84.4% for beyond expanded, P < 0.001) and disease-free survival rate was 99.1% (100, 99.3, 92.8%, respectively, P < 0.001).
Endoscopic resection for EGC showed favorable long-term clinical outcomes in the patients within the standard and expanded criteria, whereas less favorable clinical outcomes in the patients beyond the expanded criteria.
我们旨在评估早期胃癌（EGC）内镜切除的长期临床结局。
2005年至2011年期间，961例EGC患者接受了内镜黏膜下剥离术（ESD）治疗。患者被分为标准标准组和扩大标准组，而不符合扩大标准的患者则被视为超出扩大标准组。比较三组的完全切除率和长期临床结局。
标准组的完全切除率显著高于扩大标准组和超出扩大标准组；标准组为96.1%，扩大标准组为92.5%，超出扩大标准组为55.5%。在平均42个月的随访期间，超出扩大标准组（7.8%）的局部肿瘤复发比标准组和扩大标准组（1.8%）更频繁。三组之间异时性癌发病率（6.5%）无显著差异。三分之二的复发性或异时性肿瘤接受了额外的ESD治疗。发生淋巴结转移的比例为0.6%。五年总生存率为94.8%（标准组为96.6%，扩大标准组为94.2%，超出扩大标准组为84.4%，P<0.001），无病生存率为99.1%（分别为100%、99.3%、92.8%，P<0.001）。
对于符合标准标准组和扩大标准组的患者，EGC内镜切除显示出良好的长期临床结局，而对于超出扩大标准组的患者，临床结局较差。
