Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Surg Endosc. 2022 Jun;36(6):3686-3697. doi: 10.1007/s00464-022-09126-9. Epub 2022 Feb 22.
There have been concerns over the long-term outcomes of endoscopic submucosal dissection (ESD) for undifferentiated-type early gastric cancer (UD EGC). We aimed to compare the long-term outcomes of ESD and surgery for patients with UD EGC.
We searched PubMed, Embase, and Cochrane Library databases through March 2021 to identify studies that compared the long-term outcomes of ESD and surgery for UD EGC meeting expanded criteria for curative resection. The risk of bias was assessed with the Cochrane tool for non-randomized studies. The risk ratio (RR) was estimated using a fixed-effect model.
Overall, 1863 patients from five retrospective cohort studies, including 908 patients with propensity score matching (PSM), were eligible for meta-analysis. ESD was associated with inferior overall survival (OS) compared to surgery in the overall cohort (RR 2.11; 95% CI 1.26-3.55) but not in the PSM cohort (RR 1.18; 95% CI 0.60-2.32). In the PSM cohort, ESD had a lower disease-free survival (DFS) (RR 2.49; 95% CI 1.42-4.35) and higher recurrence (RR 12.61; 95% CI 3.43-46.37), gastric recurrence (RR 11.25; 95% CI 3.06-41.40), and extragastric recurrence (RR 4.23; 95% CI 0.47-37.93). Recurrence outcomes were similar between the overall and PSM cohorts. Disease-specific survival was not significantly different between the two groups in both the overall and PSM cohorts.
Although OS after curative ESD for UD EGC was not different from that after surgery in the PSM cohort, DFS and recurrence were inferior after ESD. Limitations included a lack of randomized trials. Further prospective studies comparing the long-term outcomes of ESD and surgery for UD EGC are needed (PROSPERO CRD 42021237097).
内镜黏膜下剥离术（ESD）治疗未分化型早期胃癌（UD EGC）的长期疗效存在争议。本研究旨在比较 ESD 和手术治疗符合扩大内镜下切除适应证的 UD EGC 患者的长期疗效。
我们检索了 PubMed、Embase 和 Cochrane Library 数据库，以确定比较符合扩大内镜下切除适应证的 UD EGC 患者接受 ESD 和手术治疗的长期疗效的研究。采用 Cochrane 偏倚风险评估工具评估非随机研究的偏倚风险。采用固定效应模型估计风险比（RR）。
共有 5 项回顾性队列研究的 1863 例患者（包括 908 例倾向评分匹配患者）符合纳入标准。总体而言，与手术相比，ESD 治疗 UD EGC 的总生存（OS）较差（RR 2.11；95%CI 1.26-3.55），但在倾向评分匹配队列中差异无统计学意义（RR 1.18；95%CI 0.60-2.32）。在倾向评分匹配队列中，ESD 的无病生存（DFS）（RR 2.49；95%CI 1.42-4.35）和复发率（RR 12.61；95%CI 3.43-46.37）、胃内复发率（RR 11.25；95%CI 3.06-41.40）和胃外复发率（RR 4.23；95%CI 0.47-37.93）均较高。总体和倾向评分匹配队列的复发结局相似。两组的疾病特异性生存差异均无统计学意义。
尽管在倾向评分匹配队列中，接受根治性 ESD 治疗的 UD EGC 患者的 OS 与手术治疗无差异，但 ESD 后 DFS 和复发率较低。本研究存在缺乏随机对照试验的局限性。需要进一步开展比较 ESD 和手术治疗 UD EGC 的长期疗效的前瞻性研究（PROSPERO CRD42021237097）。
