Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Gastroenterology and Endoscopy, Sapporo Kinentou Hospital, Sapporo, Japan.
J Gastroenterol Hepatol. 2022 Apr;37(4):758-765. doi: 10.1111/jgh.15798. Epub 2022 Feb 27.
Endoscopic submucosal dissection (ESD) is recommended for the treatment of early gastric cancers with an undifferentiated-type component, clinically diagnosed as intramucosal lesions ≤ 2 cm, without ulceration. In the JCOG1009/1010 trial, ESD could be performed with stomach preservation in 70% of such patients whose pathological findings met the curative resection criteria. However, additional gastrectomy was required for the remaining 30%. We identified the pretreatment risk factors for noncurative resection.
Post-hoc analysis indicated that 336 patients were identified in the JCOG1009/1010 trial; among them, 243 and 93 patients were categorized into the curative or noncurative resection groups, respectively, based on the pathological findings of the resected specimens. We explored the pretreatment risk factors for noncurative resection and investigated their associated pathological findings.
Multivariable analysis revealed that a pretreatment tumor size > 1 cm was an independent risk factor for noncurative resection (odds ratio, 3.538; 95% confidence interval, 2.020-6.198, P < 0.0001). Patients with a pretreatment tumor size > 1 cm (n = 172) had a histological tumor size > 2 cm (22.1% vs 4.3%, odds ratio, 6.313; 95% confidence interval, 2.73-14.599, P < 0.0001) and submucosal invasion (17.4% vs 9.1%, odds ratio, 2.000; 95% confidence interval, 1.032-3.877, P = 0.040) more frequently as noncurative resection findings compared with those with a tumor size < 1 cm (n = 164).
Because pretreatment tumor size > 1 cm is an independent risk factor for noncurative resection, endoscopists should be aware that noncurative resection is not uncommon in ESD and fully explain the potential necessity for additional gastrectomy to patients before the procedure.
内镜黏膜下剥离术（ESD）适用于治疗分化型早期胃癌，临床诊断为黏膜内病变≤2cm，无溃疡。在 JCOG1009/1010 试验中，对于符合治愈性切除标准的患者，70%的患者可以保留胃进行 ESD。然而，其余 30%的患者需要额外的胃切除术。我们确定了术前非治愈性切除的危险因素。
事后分析表明，JCOG1009/1010 试验共纳入 336 例患者；根据切除标本的病理结果，其中 243 例和 93 例患者分别归入治愈性或非治愈性切除组。我们探讨了术前非治愈性切除的危险因素，并对其相关的病理发现进行了研究。
多变量分析显示，术前肿瘤直径>1cm 是非治愈性切除的独立危险因素（比值比，3.538；95%置信区间，2.020-6.198，P<0.0001）。术前肿瘤直径>1cm（n=172）的患者组织学肿瘤直径>2cm（22.1%比 4.3%，比值比，6.313；95%置信区间，2.73-14.599，P<0.0001）和黏膜下浸润（17.4%比 9.1%，比值比，2.000；95%置信区间，1.032-3.877，P=0.040）更为常见，提示非治愈性切除。
由于术前肿瘤直径>1cm 是非治愈性切除的独立危险因素，内镜医生应该意识到 ESD 中非治愈性切除并不少见，并在手术前向患者充分解释潜在的额外胃切除术的必要性。
