Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Gastrointest Endosc. 2018 Feb;87(2):419-428.e3. doi: 10.1016/j.gie.2017.07.005. Epub 2017 Jul 14.
This study stratified the risk of developing metachronous gastric cancer (MGC) after curative endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) to enable customization of endoscopic surveillance for MGC.
A total of 1115 patients who underwent curative ESD based on the expanded criteria for differentiated EGC from 2005 to 2014 at a single tertiary hospital were enrolled in this retrospective cohort study. They were followed up with annual endoscopy for a median of 50.1 months. Helicobacter pylori and histologic intestinal metaplasia (IM) were evaluated. The Kaplan-Meier method and Cox regression analysis were used for risk stratification.
Three risk groups were identified: group 1 comprised patients with a synchronous neoplasm; group 2 comprised male patients with corpus IM; and group 3 comprised male patients without corpus IM or female patients. The 5- and 7-year cumulative risks (95% confidence interval [CI]) for metachronous recurrence were 15.1% (95% CI, 7.7-22.5) and 26.1% (95% CI, 14.9-37.3), respectively, in group 1; 5.6% (95% CI, 3.1-8.1) and 9.3% (95% CI, 5.4-13.2), respectively, in group 2; and 3.8% (95% CI, 1.6-6.0) and 4.9% (95% CI, 2.4-7.4), respectively, in group 3 (P < .001 by log-rank test). The incidence of MGCs increased constantly even after 5 years in groups 1 and 2 but not in group 3. There was not enough evidence to show an association between H pylori eradication and metachronous recurrence in the data.
Meticulous annual endoscopic surveillance for MGC for more than 5 years is recommended for patients with synchronous neoplasm. Endoscopic surveillance may also be extended beyond 5 years in male patients with corpus IM.
本研究对接受内镜黏膜下剥离术（ESD）治疗的早期胃癌（EGC）患者进行了异时性胃癌（MGC）发生风险分层，以便为 MGC 的内镜监测制定个体化方案。
回顾性分析 2005 年至 2014 年期间，在一家三级医院因分化型 EGC 扩大标准接受根治性 ESD 的 1115 例患者的临床资料。所有患者均接受了中位时间为 50.1 个月的年度内镜随访。评估幽门螺杆菌和组织学肠上皮化生（IM）。采用 Kaplan-Meier 法和 Cox 回归分析进行风险分层。
确定了 3 个风险组：第 1 组包括同时性肿瘤患者；第 2 组包括男性胃体 IM 患者；第 3 组包括男性胃体无 IM 或女性患者。第 1 组的 5 年和 7 年累积复发率（95%CI）分别为 15.1%（95%CI，7.7-22.5）和 26.1%（95%CI，14.9-37.3）；第 2 组分别为 5.6%（95%CI，3.1-8.1）和 9.3%（95%CI，5.4-13.2）；第 3 组分别为 3.8%（95%CI，1.6-6.0）和 4.9%（95%CI，2.4-7.4）（log-rank 检验 P<.001）。第 1 组和第 2 组 MGC 发生率在 5 年后仍持续升高，但第 3 组无此现象。数据显示，幽门螺杆菌根除与异时性复发之间无关联。
对于同时性肿瘤患者，建议进行超过 5 年的 MGC 年度内镜监测。对于男性胃体 IM 患者，内镜监测时间也可以延长至 5 年以上。
