Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan.
Gastric Cancer. 2019 May;22(3):558-566. doi: 10.1007/s10120-018-0889-8. Epub 2018 Oct 31.
Recently, endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) has been performed on patients with severe comorbidities because it is less invasive, although little is known regarding long-term outcomes. This study aimed to assess the long-term outcomes of ESD for patients with severe and non-severe comorbidities.
We enrolled 1081 patients who underwent ESD for EGC between February 2004 and June 2013. Based on the American Society of Anesthesiologists Physical Status (ASA-PS) classification, we defined patients with severe and non-severe comorbidities as ASA-PS 3 and 1/2, respectively. We retrospectively compared the overall survival, risk factors for mortality, and adverse events between these two groups using propensity score matching and inverse probability of treatment weighting.
A total of 488 patients met the eligibility criteria. After matching, the ASA-PS 3 group showed a significantly shorter survival than the ASA-PS 1/2 group (5-year overall survival rate, 79.1 vs. 87.7%; p < 0.01). In addition, only the ASA-PS 3 group had a significant risk factor for mortality using both the Cox analysis [hazard ratio (HR), 2.56; 95% confidence interval (CI) 1.18-5.52; p = 0.02] and the IPTW method (HR, 3.14; 95% CI 1.91-5.14; p < 0.01). There was no significant difference in adverse events after matching between the two groups (p = 0.21).
The long-term outcome of gastric ESD for patients with severe comorbidities was worse than for those with non-severe comorbidities. Further studies will be necessary to determine if ESD is truly warranted in these patients.
近年来，由于内镜黏膜下剥离术（ESD）具有侵袭性小的优点，已用于治疗患有严重合并症的早期胃癌（EGC）患者，但对于其长期疗效知之甚少。本研究旨在评估 ESD 治疗严重和非严重合并症患者的长期疗效。
我们纳入了 2004 年 2 月至 2013 年 6 月期间因 EGC 行 ESD 的 1081 例患者。根据美国麻醉医师协会身体状况（ASA-PS）分级，我们将患有严重和非严重合并症的患者分别定义为 ASA-PS 3 级和 1/2 级。我们采用倾向评分匹配和逆概率处理权重法，对这两组患者的总生存率、死亡风险因素和不良事件进行了回顾性比较。
共有 488 例患者符合纳入标准。匹配后，ASA-PS 3 级组的总生存率显著短于 ASA-PS 1/2 级组（5 年总生存率，79.1% vs. 87.7%；p < 0.01）。此外，仅 ASA-PS 3 级组在 Cox 分析[风险比（HR），2.56；95%置信区间（CI）1.18-5.52；p = 0.02]和 IPTW 法（HR，3.14；95%CI 1.91-5.14；p < 0.01）中均为死亡的显著风险因素。匹配后两组患者的不良事件发生率无显著差异（p = 0.21）。
患有严重合并症的患者行胃 ESD 的长期疗效差于非严重合并症患者。需要进一步研究以确定 ESD 是否确实适用于这些患者。
