Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Gut Liver. 2024 Nov 15;18(6):992-1001. doi: 10.5009/gnl230383. Epub 2024 Mar 21.
BACKGROUND/AIMS: eradication can reduce the incidence of metachronous gastric neoplasm (MGN) after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). This study evaluated the risk of developing MGN after ESD for EGC based on age at eradication.
Data of patients who underwent curative ESD for EGC with infection between 2005 and 2018 were retrospectively analyzed. The patients were allocated to four groups according to age at eradication: group 1 (<50 years), group 2 (50-59 years), group 3 (60-69 years), and group 4 (≥70 years).
All patients were followed up for at least 5 years after ESD. The 5-year cumulative incidence of MGN was 2.1%, 7.0%, 8.7%, and 16.7% in groups 1, 2, 3, and 4, respectively (p<0.001), and groups 3 and 4 showed a significant increase in the risk of MGN (hazard ratio [HR], 4.66; 95% confidence interval [CI], 1.09 to 19.92 and HR, 10.75; 95% CI, 2.45 to 47.12). After adjustments for moderate to severe intestinal metaplasia based on the updated Sydney system, groups 3 and 4 remained significantly associated with MGN (HR, 4.40; 95% CI, 1.03 to 18.84 and HR, 10.14; 95% CI, 2.31 to 44.57).
The incidence of MGN after ESD for EGC increased with age at eradication. Age at eradication ≥60 years was an independent risk factor for MGN, even after adjusting for the presence of advanced intestinal metaplasia.
背景/目的：根除 可降低内镜黏膜下剥离术（ESD）治疗早期胃癌（EGC）后发生异时性胃肿瘤（MGN）的风险。本研究基于根除时的年龄评估了 ESD 治疗 EGC 后发生 MGN 的风险。
回顾性分析了 2005 年至 2018 年间接受根治性 ESD 治疗 EGC 且存在 感染的患者数据。根据根除时的年龄将患者分为四组：组 1（<50 岁）、组 2（50-59 岁）、组 3（60-69 岁）和组 4（≥70 岁）。
所有患者在 ESD 后至少随访 5 年。组 1、2、3 和 4 的 5 年累积 MGN 发生率分别为 2.1%、7.0%、8.7%和 16.7%（p<0.001），组 3 和 4 的 MGN 风险显著增加（危险比[HR]，4.66；95%置信区间[CI]，1.09 至 19.92 和 HR，10.75；95% CI，2.45 至 47.12）。根据更新的悉尼系统对中重度肠上皮化生进行调整后，组 3 和 4 仍与 MGN 显著相关（HR，4.40；95% CI，1.03 至 18.84 和 HR，10.14；95% CI，2.31 至 44.57）。
ESD 治疗 EGC 后 MGN 的发生率随根除时的年龄增加而增加。根除时年龄≥60 岁是 MGN 的独立危险因素，即使在调整了高级别肠上皮化生的存在后也是如此。
