Characteristics of Metachronous Gastric Tumors after Endoscopic Submucosal Dissection for Gastric Intraepithelial Neoplasms

Abstract

Background. Recently, endoscopic submucosal dissection (ESD) has become a standard treatment method for early gastric cancer and concurrent stomach preservation. However, metachronous recurrences have become a major problem. We evaluated the incidence and clinicopathologic features of and examined the risk factors for metachronous gastric tumors. Methods. A total of 357 patients who underwent ESD for gastric tumors (245 early gastric cancers and 112 adenomas) and were followed up for more than 12 months without recurrence within the first 12 months were enrolled. We investigated the incidence and clinicopathologic features of metachronous tumors after ESD. We also analyzed the potential risk factors for metachronous tumors using the Kaplan-Meier method and Cox's proportional hazards model. Results. The annual incidence of metachronous tumors after ESD was 2.4%. The median period until discovery after initial ESD was 26.0 months, and the median observation period was 52.6 months. Male patients developed metachronous tumors more frequently (P = 0.04), and the hazard ratio of female to male patients was 0.36 (95% confidence interval: 0.11–0.89). Conclusions. Patients with a previous history of gastric tumors have a high risk of subsequent gastric tumor development and male patients should be carefully followed up after ESD for gastric tumor.

Genetic Profile Analysis of a Patient with Metachronous Gastric Cancer with a Family History of Gastrointestinal Cancers

“…The risk factors of recurrence were H. pylori infection, male gender and microsatellite instability. 17,18 Considering one report describing patients with a positive family history of cancer tended to have a greater risk of recurrence after subtotal gastrectomy of early gastric cancer, 19 we might suggest the family history of our patient contribute to cancer recurrence. In our case, the patient underwent subtotal gastrectomy and did not receive any chemotherapy or radiotherapy.…”

Helicobacter pylori Eradication for Metachronous Gastric Cancer: An Unsuitable Methodology Impeding Broader Clinical Usage

“…Additionally, the authors of this study (9) should have provided a more comprehensive literature background for the 1-year clinical cutoff that they used to define metachronous cancer to provide a sense of comparability, regardless of whether all the results are recorded at 5 years; notable examples include studies by Nakajima et al (21), Park et al (22), Abe et al (23), and Boda et al (24). These contrast with the more commonly used cutoff of 6 months (Moertel definition) (25).…”

Risk Assessment of Metachronous Gastric Neoplasm after Endoscopic Resection for Early Gastric Cancer According to Age at Helicobacter pylori Eradication

“…6 In addition, previous studies have reported annual incidence rates of MGN ranging from 2.4% to 4.7%. [7][8][9] Therefore, the risk of MGN has become a major concern for patients who underwent ESD for EGC. 10 To date, previous studies have identified several risk factors of the development of MGN after endoscopic resection for EGC.…”