Kato Motohiko, Nishida Tsutomu, Hamasaki Toshimitsu, Kawai Naoki, Yoshio Toshiyuki, Egawa Satoshi, Yamamoto Katsumi, Ogiyama Hideharu, Komori Masato, Nakahara Masanori, Yabuta Takamasa, Nishihara Akihiro, Hayashi Yoshito, Yamada Takuya, Takehara Tetsuo
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan,
Surg Endosc. 2015 Jun;29(6):1560-6. doi: 10.1007/s00464-014-3841-y. Epub 2014 Oct 8.
Gastric cancer and liver cirrhosis (LC) are often comorbid. However, little is known about the clinical outcomes of gastric endoscopic submucosal dissection (ESD) in patients with comorbid LC.
This case-control study used a multicentre retrospective cohort. We identified 69 LC patients from the cohort of patients with early gastric cancer, who underwent gastric ESD at 12 hospitals from March 2003 to November 2010. Using the propensity score matching method, 69 patients without LC were used to compare the short- and long-term outcomes of ESD.
Among the 69 LC patients, 53 (77 %) were Child-Pugh grade A (CP-A) and 16 (28 %) had past or present histories of hepatocellular carcinoma (HCC). Short-term outcomes did not differ between the LC patients and controls or between the CP-A and CP-B/C patients. Although the LC patients had significantly worse long-term outcomes than the controls (the 5-year overall survival rates were 60 vs. 91 %, respectively), patients with CP-A liver function without HCC histories had an overall survival almost equivalent to that of patients without LC (controls).
LC patients appear to be good candidates for ESD if they have CP-A liver function and no history of HCC. Although their short-term outcomes were not inferior, the patients with Child-Pugh grades B/C or with histories of HCC benefited less from ESD.
胃癌与肝硬化（LC）常合并存在。然而，关于合并LC的患者接受胃内镜黏膜下剥离术（ESD）的临床结局知之甚少。
本病例对照研究采用多中心回顾性队列研究。我们从早期胃癌患者队列中识别出69例LC患者，这些患者于2003年3月至2010年11月在12家医院接受了胃ESD。采用倾向评分匹配法，选取69例无LC的患者比较ESD的短期和长期结局。
69例LC患者中，53例（77%）为Child-Pugh A级（CP-A），16例（28%）有既往或当前肝细胞癌（HCC）病史。LC患者与对照组之间以及CP-A组与CP-B/C组患者之间的短期结局无差异。尽管LC患者的长期结局明显比对照组差（5年总生存率分别为60%和91%），但肝功能为CP-A且无HCC病史的患者的总生存率几乎与无LC的患者（对照组）相当。
如果LC患者肝功能为CP-A且无HCC病史，似乎是ESD的合适人选。尽管他们的短期结局并不差，但Child-Pugh B/C级或有HCC病史的患者从ESD中获益较少。
