Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Pusan, Korea.
PLoS One. 2018 Oct 24;13(10):e0206179. doi: 10.1371/journal.pone.0206179. eCollection 2018.
Endoscopic submucosal dissection (ESD) has been accepted as the treatment of choice for early gastric cancer (EGC) without lymph node metastasis. However, additional surgical gastrectomy should be considered after non-curative endoscopic resection. We aimed to evaluate the predictive factors associated with non-curative endoscopic resection.
Between November 2008 and June 2015, a retrospective study was conducted in a single, tertiary, referral hospital. A total of 596 EGC lesions resected by ESD were analyzed. Non-curative endoscopic resection was defined as the occurrence of lesions associated with piecemeal resection, positive resection margins, lymphovascular invasion, or lesions that did not meet the expanded indications for ESD.
The rate of non-curative endoscopic resection was 16.1%. The mean follow-up period was 35.3 ± 25.0 months. Associated predictive factors for non-curative endoscopic resection were female sex (OR, 2.470; p = 0.004), lesion size ≥ 20 mm (OR 3.714; p < 0.001), longer procedure time (OR 2.449, p = 0.002), ulceration (OR 3.538, p = 0.002), nodularity (OR 2.967, p<0.001), depression (OR 1.806, p = 0.038), undifferentiated carcinoma (OR 2.825, p = 0.031) and lesion located in the mid or upper third of stomach (OR 7.135 and OR 4.155, p<0.001, respectively). As the number of risk factors increased, the risk of non-curative ESD also increased.
Prior to selection of ESD, the risks associated with non-curative ESD should be considered so that appropriate treatment modalities may be selected.
内镜黏膜下剥离术（ESD）已被接受为无淋巴结转移的早期胃癌（EGC）的治疗选择。然而，在非治愈性内镜切除后应考虑额外的外科胃切除术。我们旨在评估与非治愈性内镜切除相关的预测因素。
2008 年 11 月至 2015 年 6 月，在一家单一的三级转诊医院进行了一项回顾性研究。对 596 例通过 ESD 切除的 EGC 病变进行了分析。非治愈性内镜切除的定义为发生与分片切除、阳性切缘、淋巴管血管侵犯或不符合 ESD 扩大适应证相关的病变。
非治愈性内镜切除率为 16.1%。平均随访时间为 35.3±25.0 个月。非治愈性内镜切除的相关预测因素包括女性（OR，2.470；p=0.004）、病变大小≥20mm（OR，3.714；p<0.001）、手术时间较长（OR，2.449，p=0.002）、溃疡（OR，3.538，p=0.002）、结节状（OR，2.967，p<0.001）、凹陷（OR，1.806，p=0.038）、未分化癌（OR，2.825，p=0.031）和病变位于胃中或上部（OR，7.135 和 OR，4.155，p<0.001）。随着危险因素数量的增加，非治愈性 ESD 的风险也随之增加。
在选择 ESD 之前，应考虑非治愈性 ESD 的相关风险，以便选择适当的治疗方式。
