内镜黏膜下剥离术治疗早期胃癌的长期疗效与手术相当：一项倾向评分匹配分析。
Long-term outcome of endoscopic submucosal dissection is comparable to that of surgery for early gastric cancer: a propensity-matched analysis.
机构信息
Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 602-739, Korea.
Department of Pathology, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
出版信息
Gastric Cancer. 2018 Jan;21(1):133-143. doi: 10.1007/s10120-017-0719-4. Epub 2017 Apr 10.
BACKGROUND
Data concerning the long-term outcomes of endoscopic submucosal dissection (ESD) versus surgery for early gastric cancer (EGC) are limited. We aimed to compare the long-term outcomes of ESD and surgery for patients with EGC.
METHODS
Data were reviewed from patients treated by ESD or surgery for EGC in 2005-2010. The primary outcome was overall survival (OS). Secondary outcomes were disease-specific survival (DSS), disease-free survival (DFS), recurrence-free survival (RFS), treatment-related complications, and hospital stay duration.
RESULTS
Among 617 patients, 342 underwent ESD and 275 underwent surgery. The 5-year OS rates were similar between the ESD group and the surgery group (96.9% vs 98.1%, P = 0.581). In a propensity-score-matched analysis of 117 pairs, there were no significant differences in the OS rates (96.5% vs 99.1%, P = 0.125) and DSS rates (100% vs 99.1%, P = 0.317) between the ESD group and the surgery group. The ESD group had a significantly lower DFS rate (90.3% vs 98.0%, P = 0.002), a significantly lower RFS rate (95.1% vs 98.0%, P = 0.033), a significantly higher early complication rate (6.7% vs 1.5%, P < 0.001), a significantly lower late complication rate (0% vs 9.1%, P < 0.001), and a significantly shorter median hospital stay (3 days vs 10 days, P < 0.001) than the surgery group.
CONCLUSIONS
ESD and surgery have comparable OS rates in patients with EGC. ESD has benefits, including a lower late complication rate and shorter hospital stay. However, RFS and DFS rates might be lower after ESD than after surgery.
背景
内镜黏膜下剥离术（ESD）与手术治疗早期胃癌（EGC）的长期疗效数据有限。本研究旨在比较 ESD 和手术治疗 EGC 的长期疗效。
方法
回顾 2005 年至 2010 年接受 ESD 或手术治疗的 EGC 患者的数据。主要终点为总生存（OS）。次要终点包括疾病特异性生存（DSS）、无病生存（DFS）、无复发生存（RFS）、治疗相关并发症和住院时间。
结果
在 617 例患者中，342 例行 ESD，275 例行手术。ESD 组和手术组的 5 年 OS 率相似（96.9% vs 98.1%，P=0.581）。在 117 对倾向评分匹配分析中，ESD 组和手术组的 OS 率（96.5% vs 99.1%，P=0.125）和 DSS 率（100% vs 99.1%，P=0.317）无显著差异。ESD 组的 DFS 率（90.3% vs 98.0%，P=0.002）、RFS 率（95.1% vs 98.0%，P=0.033）显著较低，早期并发症发生率（6.7% vs 1.5%，P<0.001）显著较高，晚期并发症发生率（0% vs 9.1%，P<0.001）显著较低，中位住院时间（3 天 vs 10 天，P<0.001）显著较短。
结论
ESD 和手术治疗 EGC 的 OS 率相当。ESD 具有较低的晚期并发症发生率和较短的住院时间的优势。然而，与手术相比，ESD 后 RFS 和 DFS 率可能较低。
Zotero 插件