Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
Surg Endosc. 2018 Feb;32(2):846-854. doi: 10.1007/s00464-017-5753-0. Epub 2017 Jul 21.
Whether surveillance strategy after curative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) differs in young patients is unclear. This study aimed to evaluate the risk of metachronous and extragastric recurrence in young patients with EGC after curative ESD.
We retrospectively enrolled 1237 consecutive patients who underwent curative ESD for EGC from 2005 to 2014 at a single tertiary hospital. The patients were divided into group 1 (<50 years of age, n = 86), group 2 (age 50-74, n = 985), or group 3 (≥75 years of age, n = 166). The clinical characteristics and outcomes were compared among the three age groups.
Group 1 had more frequent Helicobacter pylori infection (P < 0.001), less frequent intestinal metaplasia (P = 0.021), and more frequent undifferentiated tumors (P = 0.039). Although the 5-year risk of developing metachronous recurrence appeared to be lower in group 1 (2.7%) than in groups 2 (8.6%) or 3 (8.7%), the risk became quite similar at the 7-year follow-up (6.4, 12.7, and 8.7% for groups 1, 2, and 3, respectively; P = 0.409 by log-rank test). Extragastric recurrences developed in only 2 cases in group 2 (0.2%).
Surveillance for metachronous and extragastric recurrence after curative ESD in patients <50 years of age should not be different from that in patients ≥50 years of age. Endoscopic surveillance for metachronous recurrence should be continued for longer than 5 years, even in young patients.
内镜黏膜下剥离术（ESD）治疗早期胃癌（EGC）后，年轻患者的监测策略是否不同尚不清楚。本研究旨在评估 EGC 行 ESD 根治性治疗后年轻患者发生异时性和胃外复发的风险。
我们回顾性纳入了 2005 年至 2014 年在一家三级医院接受 ESD 治疗的 1237 例连续 EGC 患者。将患者分为 1 组（年龄<50 岁，n=86）、2 组（年龄 50-74 岁，n=985）或 3 组（年龄≥75 岁，n=166）。比较三组的临床特征和结局。
1 组患者 H. pylori 感染更为常见（P<0.001），肠化生发生率更低（P=0.021），未分化肿瘤更为常见（P=0.039）。尽管 1 组（2.7%）5 年异时性复发风险似乎低于 2 组（8.6%）或 3 组（8.7%），但 7 年随访时风险变得非常相似（1 组、2 组和 3 组分别为 6.4%、12.7%和 8.7%；log-rank 检验 P=0.409）。2 组仅 2 例（0.2%）发生胃外复发。
50 岁以下患者 ESD 根治性治疗后异时性和胃外复发的监测策略不应与≥50 岁患者不同。即使是年轻患者，对异时性复发的内镜监测也应持续 5 年以上。
