Yang Hyo-Joon, Nam Su Youn, Min Byung-Hoon, Ahn Ji Yong, Jang Jae-Young, Kim Jung, Kim Jie-Hyun, Lee Wan-Sik, Lee Bong Eun, Joo Moon Kyung, Park Jae Myung, Shin Woon Geon, Lee Hang Lak, Gweon Tae-Geun, Park Moo In, Choi Jeongmin, Tae Chung Hyun, Kim Young-Il, Choi Il Ju
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, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, Korea.
Gastric Cancer. 2021 Mar;24(2):435-444. doi: 10.1007/s10120-020-01115-y. Epub 2020 Aug 24.
This study investigated the long-term clinical outcomes of endoscopic resection (ER) for undifferentiated-type (UD) early gastric cancer (EGC), with tumor size > 2 cm as the only non-curative factor.
From among 1123 patients who underwent ER for UD EGC at 18 tertiary hospitals in Korea between 2005 and 2014, we identified 216 patients with UD intramucosal EGC > 2 cm, which was completely resected, with negative resection margins, and absence of ulceration and lymphovascular invasion. The patients were divided into the additional surgery (n = 40) or observation (n = 176) groups, according to post-ER management and were followed up for a median duration of 59 months for recurrence and 90 months for overall survival.
Lymph node (LN) or distant metastasis or cancer-related mortality was not observed in the surgery group. In the observation group, two (1.1%) patients developed LN or distant metastasis with a 5-year cumulative risk of 0.7%, and one (0.6%) patient died of gastric cancer. The 5- and 8-year overall survival rates were 94.1% and 89.9%, respectively, in the observation group and 100.0% and 95.2%, respectively, in the surgery group (log-rank P = 0.159). Cox regression analysis did not reveal an association between the observation group and increased mortality.
The risk of LN or distant metastasis was not negligible, but as low as 1% for patients undergoing non-curative ER for UD EGC, with tumor size > 2 cm as the only non-curative factor. Close observation may be an alternative to surgery, especially for older patients or those with poor physical status.
本研究调查了以肿瘤大小>2 cm作为唯一非治愈性因素的未分化型（UD）早期胃癌（EGC）内镜切除术（ER）的长期临床结局。
在2005年至2014年间韩国18家三级医院接受UD EGC内镜切除术的1123例患者中，我们确定了216例肿瘤大小>2 cm的UD黏膜内EGC患者，这些患者均接受了完整切除，切缘阴性，且无溃疡和淋巴管侵犯。根据ER术后管理，将患者分为追加手术组（n = 40）或观察组（n = 176），并对复发情况进行了中位时间为59个月的随访，对总生存期进行了90个月的随访。
手术组未观察到淋巴结（LN）转移、远处转移或癌症相关死亡。在观察组中，2例（1.1%）患者发生LN转移或远处转移，5年累积风险为0.7%，1例（0.6%）患者死于胃癌。观察组的5年和8年总生存率分别为94.1%和89.9%，手术组分别为100.0%和95.2%（对数秩检验P = 0.159）。Cox回归分析未显示观察组与死亡率增加之间存在关联。
对于以肿瘤大小>2 cm作为唯一非治愈性因素的UD EGC患者，接受非治愈性ER后发生LN转移或远处转移的风险不可忽略，但低至1%。密切观察可能是手术的替代方案，特别是对于老年患者或身体状况较差的患者。
