Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle-upon-Tyne, UK.
Department of Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
Ann Surg Oncol. 2021 Jun;28(6):2992-2998. doi: 10.1245/s10434-020-09485-4. Epub 2021 Jan 15.
The role of endoscopic resection (ER) in the management of subsets of clinical T1N0 gastric adenocarcinoma remains controversial. The aim of this study was to evaluate the outcome of ER versus gastrectomy in node-negative cT1a and cT1b gastric adenocarcinoma.
Data from the National Cancer Database (2010-2015) were used to identify patients with clinical T1aN0 (n = 2927; ER: n = 1157, gastrectomy: n = 1770) and T1bN0 (n = 2915; ER: n = 474, gastrectomy: n = 2441) gastric adenocarcinoma. Propensity score matching and Cox multivariable analyses were used to account for treatment selection bias.
ER for cT1a and cT1b cancers was performed more frequently over time. The rates of node-positive disease in patients with cT1a and cT1b gastric adenocarcinoma were 5% and 18%, respectively. In the matched cohort, gastrectomy was associated with increased survival compared with ER for cT1a cancers (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.66-0.95; p = 0.013), and corresponding 5-year survival for gastrectomy and ER was 72% and 66%, respectively (p = 0.013). For cT1b cancers, gastrectomy had a significantly longer survival compared with ER (HR 0.77, 95% CI 0.63-0.93; p = 0.008), and the corresponding 5-year survival for gastrectomy and ER was 60% and 50%, respectively (p = 0.013).
This study demonstrates ER is inferior in terms of long-term survival for clinical T1aN0 and T1bN0 gastric adenocarcinoma, despite current recommendations for ER in cT1 gastric cancers. Future research should seek to identify the subset of T1a and T1b cancers at low risk of nodal metastasis, and would thus maximally benefit from ER.
内镜下切除术（ER）在治疗临床 T1N0 胃腺癌亚组中的作用仍存在争议。本研究旨在评估 ER 与淋巴结阴性 cT1a 和 cT1b 胃腺癌患者行胃切除术的结果。
利用国家癌症数据库（2010-2015 年）的数据，识别临床 T1aN0（n=2927；ER：n=1157，胃切除术：n=1770）和 T1bN0（n=2915；ER：n=474，胃切除术：n=2441）胃腺癌患者。采用倾向评分匹配和 Cox 多变量分析来纠正治疗选择偏倚。
ER 治疗 cT1a 和 cT1b 癌症的比例随时间推移逐渐增加。cT1a 和 cT1b 胃腺癌患者中，阳性淋巴结的比例分别为 5%和 18%。在匹配队列中，与 ER 相比，胃切除术与 cT1a 癌症患者的生存获益相关（风险比[HR]0.79，95%置信区间[CI]0.66-0.95；p=0.013），胃切除术和 ER 的 5 年生存率分别为 72%和 66%（p=0.013）。对于 cT1b 癌症，与 ER 相比，胃切除术的生存时间明显更长（HR 0.77，95%CI 0.63-0.93；p=0.008），胃切除术和 ER 的 5 年生存率分别为 60%和 50%（p=0.013）。
尽管目前推荐对 cT1 胃腺癌进行 ER，但本研究表明，对于临床 T1aN0 和 T1bN0 胃腺癌，ER 的长期生存获益较低。未来的研究应努力确定低淋巴结转移风险的 T1a 和 T1b 癌症亚组，并使这些患者最大程度地受益于 ER。
