Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan.
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Gastrointest Endosc. 2019 May;89(5):950-960. doi: 10.1016/j.gie.2018.11.015. Epub 2018 Nov 19.
Cancer recurrence is observed in some patients without additional radical surgery after endoscopic submucosal dissection (ESD) that does not fulfill the curability criteria for early gastric cancer (EGC), categorized as "noncurative resection" or "curability C-2" in the guidelines. However, time to cancer recurrence is different in such patients. Thus, we aimed to identify the risk factors of early and late cancer recurrences in these patients.
Between 2000 and 2011, this multicenter study analyzed 905 patients who were followed up without additional radical surgery after ESD for EGC categorized as curability C-2. We evaluated the risk factors for early and late cancer recurrences, separately, after ESD. The cut-off value was defined at 2 years.
Time to cancer recurrence in the enrolled patients showed a bimodal pattern, and the 5-year cancer recurrence rate was 3.2%. Multivariate Cox analyses revealed that lymphatic invasion (hazard ratio [HR], 8.56; P = .003) was the sole independent risk factor for early cancer recurrence. Regarding late cancer recurrence, vascular invasion (HR, 4.50; P = .039) was an independent risk factor, and lymphatic invasion tended to be a risk factor (HR, 3.63; P = .069).
This multicenter study with a large cohort demonstrated that lymphatic invasion is mainly associated with early cancer recurrence; however, vascular invasion was a risk factor only for late recurrence in patients without additional treatment after ESD for EGC categorized as curability C-2. This finding may contribute to decision making for treatment strategies after ESD, especially for patients with a relatively short life expectancy.
内镜黏膜下剥离术（ESD）后，一些不符合早期胃癌（EGC）治愈标准的患者（被归类为“非治愈性切除”或指南中的“治愈性 C-2”）未进行额外的根治性手术，观察到癌症复发。然而，这些患者的癌症复发时间不同。因此，我们旨在确定这些患者早期和晚期癌症复发的危险因素。
在 2000 年至 2011 年期间，这项多中心研究分析了 905 例 EGC 患者，这些患者在 ESD 后未接受额外的根治性手术，且被归类为治愈性 C-2。我们分别评估了 ESD 后早期和晚期癌症复发的危险因素。截止值定义为 2 年。
入组患者的癌症复发时间呈双峰模式，5 年癌症复发率为 3.2%。多变量 Cox 分析显示，淋巴管浸润（危险比 [HR]，8.56；P=.003）是早期癌症复发的唯一独立危险因素。关于晚期癌症复发，血管浸润（HR，4.50；P=.039）是独立的危险因素，淋巴管浸润也有成为危险因素的趋势（HR，3.63；P=.069）。
这项多中心、大样本队列研究表明，淋巴管浸润主要与早期癌症复发相关；然而，血管浸润是 ESD 后未接受额外治疗的 EGC 患者（归类为治愈性 C-2）中晚期复发的唯一危险因素。这一发现可能有助于制定 ESD 后的治疗策略决策，特别是对于预期寿命较短的患者。
