Sohn Se Hoon, Lee Si Hyung, Kim Kyeong Ok, Jang Byung Ik, Kim Tae Nyeun
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Yeungnam University College of Medicine, Daegu, Korea.
Eur J Gastroenterol Hepatol. 2017 Jan;29(1):61-67. doi: 10.1097/MEG.0000000000000718.
Endoscopic submucosal dissection (ESD) has been widely accepted for selected patients with early gastric cancer (EGC). The aim of this study was to assess the therapeutic outcomes after ESD according to the pathological extent.
From January 2005 to December 2014, a total of 599 patients with 611 lesions were enrolled in this study. The tumors were categorized according to pathological results on the basis of absolute criteria (AC), expanded criteria (EC), EC with undifferentiated histology [(EC-U), mucosal cancer, ulcer (-), ≤20 mm], or beyond EC (BEC). The therapeutic outcomes among the four groups were analyzed retrospectively.
The number of patients in the AC, EC, EC-U, and BEC groups was 447, 91, 19, and 54. The complete resection rates of EGC were 97.8, 84.6, 94.4, and 45.5% (P=0.001) and en bloc resection rates in the AC, EC, EC-U, and BEC groups were 99.1, 98.9, 100, and 98.1% (P=0.833), respectively. The 5-year disease-free survival rate in the AC, EC, EC-U, and BEC groups was 90.6, 88.7, 75.0, and 83.3% (P=0.394). In multivariate analysis, undifferentiated histology (P=0.001) and tumor size (>30 mm, P=0.017) were risk factors related to local recurrence.
The efficacy of ESD for EGCs in EC is almost equal to that in AC when complete resection was achieved. However, the indication for ESD should be decided conservatively because the complete resection rate of EGC in the EC group was significantly lower than that in the AC group. Undifferentiated histology and tumor size over 30 mm were risk factors related to local recurrence.
内镜黏膜下剥离术（ESD）已被广泛应用于部分早期胃癌（EGC）患者。本研究旨在根据病理范围评估ESD后的治疗效果。
2005年1月至2014年12月，本研究共纳入599例患者的611个病变。根据绝对标准（AC）、扩展标准（EC）、伴有未分化组织学的扩展标准[(EC-U)，黏膜癌，溃疡（-），≤20 mm]或超出扩展标准（BEC）的病理结果对肿瘤进行分类。对四组患者的治疗效果进行回顾性分析。
AC组、EC组、EC-U组和BEC组的患者人数分别为447例、91例、19例和54例。EGC的完整切除率分别为97.8%、84.6%、94.4%和45.5%（P=0.001），AC组、EC组、EC-U组和BEC组的整块切除率分别为99.1%、98.9%、100%和98.1%（P=0.833）。AC组、EC组、EC-U组和BEC组的5年无病生存率分别为90.6%、88.7%、75.0%和83.3%（P=0.394）。多因素分析显示，未分化组织学（P=0.001）和肿瘤大小（>30 mm，P=0.017）是与局部复发相关的危险因素。
当实现完整切除时，ESD治疗EC中EGC的疗效与AC中几乎相当。然而，ESD的适应证应谨慎决定，因为EC组中EGC的完整切除率显著低于AC组。未分化组织学和肿瘤大小超过30 mm是与局部复发相关的危险因素。
