Fan Ting, Sun Qi, Cao Shouli, Fan Xiangshan, Huang Qin, Zhang Shu, Lv Ying, Zhang Xiaoqi, Ling Tingsheng, Wang Lei, Zou Xiaoping, Xu Guifang
Department of Gastroenterology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
BMC Gastroenterol. 2021 Mar 12;21(1):119. doi: 10.1186/s12876-021-01700-0.
Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications.
From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups.
The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% (P = 0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively (P < 0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% (P < 0.001). The distant metastasis rate was 0.4%, 0% and 2.3% (P = 0.150). The five-year disease-specific survival rate in the BEI group was 96.6% (P = 0.016), compared to 99.6% in the AI group and 100% in the EI group.
The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.
内镜黏膜下剥离术（ESD）已被公认为早期贲门胃癌（EGCC）的标准治疗方法。在此，我们研究了不同适应证下接受ESD治疗的EGCC患者的临床结局。
2011年1月至2019年10月，我们纳入了在本中心接受ESD切除的495例患者的502个EGCC病变。我们回顾性分析了不同适应证组的短期和长期临床结局。
绝对适应证（AI）组、扩大适应证（EI）组和超扩大适应证（BEI）组的患者人数分别为265例、137例和93例。整块切除率分别为100%、100%和98.9%（P = 0.185）。完整切除率分别为99.3%、98.5%和74.5%（P < 0.001）。在中位随访48.1个月期间，淋巴结转移率分别为0%、0%和2.3%（P < 0.001）。远处转移率分别为0.4%、0%和2.3%（P = 0.150）。BEI组的五年疾病特异性生存率为96.6%（P = 0.016），而AI组为99.6%，EI组为100%。
EI组ESD患者的疗效与AI组几乎相当。BEI组患者总体临床结局良好，ESD术后需要仔细检查。ESD可能是不适宜行胃切除术患者的一种可选治疗方法。
