Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Gut Liver. 2021 Sep 15;15(5):723-731. doi: 10.5009/gnl20291.
BACKGROUND/AIMS: This study examined the long-term outcomes of undifferentiated-type early gastric cancer (UD EGC) with positive horizontal margins (HMs) after endoscopic resection (ER) and compared them between additional surgery and nonsurgical management.
From 2005 to 2015, a total of 1,124 patients with UD EGC underwent ER at 18 tertiary hospitals in Korea. Of them, 92 patients with positive HMs as the only noncurative factor (n=25) or with both positive HMs and tumor size >2 cm (n=67) were included. These patients underwent additional surgery (n=40), underwent additional endoscopic treatment (n=6), or were followed up without further treatment (n=46).
No lymph node (LN) metastasis was found in patients who underwent additional surgery. During a median follow-up of 57.7 months (interquartile range, 27.6 to 68.8 months), no LN or distant metastases or gastric cancer-related deaths occurred in the overall cohort. At baseline, the residual cancer rate was 57.8% (26/45) after additional surgery or ER. The 5-year local recurrence rate was 33.6% among patients who were followed up without additional treatment. The 5-year overall survival rates were 95.0% and 87.8% after additional surgery and nonsurgical management (endoscopic treatment or close follow-up), respectively (log-rank p=0.224). In the multivariate Cox regression analysis, nonsurgical management was not associated with an increased risk of mortality.
UD EGC with positive HMs after ER may have favorable long-term outcomes and a very low risk of LN metastasis. Nonsurgical management may be suggested as an alternative, particularly for patients with old age or chronic illness.
背景/目的：本研究旨在探讨内镜下切除（ER）后水平切缘阳性（HM）的未分化型早期胃癌（UD EGC）的长期预后，并比较追加手术与非手术治疗之间的差异。
2005 年至 2015 年，韩国 18 家三级医院共对 1124 例 UD EGC 患者进行了 ER，其中 92 例 HM 阳性为唯一非治愈因素（n=25）或 HM 阳性且肿瘤直径>2cm（n=67）的患者被纳入研究。这些患者分别接受了追加手术（n=40）、追加内镜治疗（n=6）或未进一步治疗（n=46）。
接受追加手术的患者未发现淋巴结（LN）转移。在中位随访 57.7 个月（27.6 至 68.8 个月）期间，全队列患者均未发生 LN 或远处转移或与胃癌相关的死亡。基线时，追加手术或 ER 后残留癌率为 57.8%（26/45）。未进一步治疗的患者 5 年局部复发率为 33.6%。追加手术和非手术治疗（内镜治疗或密切随访）后 5 年的总生存率分别为 95.0%和 87.8%（对数秩检验 p=0.224）。多因素 Cox 回归分析显示，非手术治疗与死亡率增加无关。
ER 后 HM 阳性的 UD EGC 可能具有良好的长期预后，且 LN 转移的风险极低。对于老年或合并慢性疾病的患者，非手术治疗可能是一种替代方案。
