Clinical Outcomes of Metachronous Gastric Cancer after Endoscopic Resection for Early Gastric Cancer

Abstract

Background/Aims: Patients treated with endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) are at risk of developing metachronous gastric cancer (MGC). The aim of this study was to evaluate the clinical outcomes of MGC after ESD for EGC between the re-ESD and surgery groups. Methods: In total, data from 1,510 patients who underwent ESD for EGC from January 2005 to May 2014 were retrospectively reviewed, and data from 112 patients with MGC were analyzed according to the type of treatment, namely, re-ESD and surgery. The clinicopathological factors affecting the subsequent treatment and outcomes of MGC were evaluated. Results: The median duration to the development of MGC was 47 months. In multivariate analysis, lower body mass index (BMI) (p=0.037) and multiplicity (p=0.014) of index cases were significantly associated with subsequent surgery for MGC. In cases of MGC, a diffuse or mixed-type Lauren classification (p=0.009), the depth of tumor mucosal invasion (p=0.001), and an upper stomach location (p=0.049) were associated with surgery. Overall survival was significantly shorter in the surgery group than in the re-ESD group after treatment for MGC (log-rank test, p=0.01). Conclusions: Lower BMI and multiplicity of index cancers were significantly associated with the surgical resection of MGC. Close follow-up is needed to minimize additional treatment for cases at high risk of advanced MGC after ESD for EGC.

Risk factors of tumor invasion and node metastasis in early gastric cancer with undifferentiated component: a multicenter retrospective study on biopsy specimens and clinical data

“…It was demonstrated that high BMI (≥25 kg/m 2 ) increased the risk of EGC or mucosal dysplasia (36), with insulin resistance playing an important role (37). But other studies showed that lower BMI was associated with metachronous GC (38) and worse survival of EGC patients (39). Our analysis identified BMI as a protective factor of both LNM and LVI in EGC-UDC, which was consistent with previous findings that BMI was inversely associated with tumor size, tumor depth, LNM and tumor stage in early or advanced GC (40,41).…”

Impact of endoscopy intervals on metachronous gastric cancer after endoscopic submucosal dissection: Comparison between 1 year and half‐a‐year

“…Through a literature review, we found only one previous study; it reported body mass index (BMI) and the multiplicity of initial gastric cancers as independent predictors. 15 Therefore, based on this study and our clinical knowledge, we chose nine possible confounders: age, sex, BMI, smoking, American Society of Anesthesiologists physical status, the degree of gastric mucosal atrophy, persistent H. pylori infection, the multiplicity of initial gastric cancers, and the curability of the first ESD. The PS models were then used to match the short-and regularinterval groups at a 1:2 ratio within a caliper width of 0.2 using a greedy nearest-neighbor algorithm.…”

Management of patients with multiple primary сancer in the practice of a modern oncologist. Case report and literature review

“…При выборе данной хирургической методики желудок сохраняет свою функцию, существенно не страдает качество жизни пациента [38]. Недостатком резекции желудка является риск развития МРЖ в нерезецированной части органа, частота которого составляет 2,7-15,6 % [36,39,40]. Основными факторами риска данного процесса являются пожилой возраст, неоднократный ранний рак желудка в анамнезе, а также персистенция H. pylori [39].…”