Long-term outcome of endoscopic submucosal dissection for early gastric cancer in patients with severe comorbidities: a comparative propensity score analysis

Tanoue, Kojiro; Fukunaga, Shusei; Nagami, Yasuaki; Sakai, Tetsuhiro; Maruyama, Hirotsugu; Ominami, Masaki; Otani, Koji; Hosomi, Shuhei; Tanaka, Fumio; Taira, Koichi; Kamata, Noriko; Yamagami, Hirokazu; Tanigawa, Tetsuya; Shiba, Masatsugu; Watanabe, Toshio; Fujiwara, Yasuhiro

doi:10.1007/s10120-018-0889-8

Cited by 29 publications

(23 citation statements)

References 31 publications

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“…The values of them were divided into high and low; Eastern Cooperative Oncology Group performance status ( E C O G -P S ) ( < 2 , ≥ 2 ) , A m e r i c a n S o c i e t y o f Anesthesiologists physical status (ASA-PS) (< 3, ≥ 3), Charlson comorbidity index (CCI) (< 2, ≥ 2), PNI (< 45, ≥ 45), modified GPS (mGPS) (< 1, ≥ 1), CAR, neutrophil/ lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and psoas muscle mass index (PMI, cm 2 /m 2 ) for evaluating sarcopenia. The cut-offs of the former 5 indices were based on previous reports (Onodera et al 1984;Toiyama et al 2011;Zhang et al 2015;Dolan et al 2019;Nakajo et al 2019;Tanoue et al 2019). Since CAR, NLR, and PLR have no definite cut-offs for predicting OS, the cut-offs of them were determined using receiver-operating characteristic (ROC) curve analysis; the values that maximized the sum of sensitivity and specificity for OS were used as the cut-offs.…”

Section: Outcome Measuresmentioning

confidence: 99%

Predictors of Early and Late Mortality after Endoscopic Resection for Esophageal Squamous Cell Carcinoma

Ogata

Hatta

Koike

et al. 2021

Tohoku J. Exp. Med.

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In esophageal squamous cell carcinoma (ESCC) comprising 90% of cases with esophageal cancer, endoscopic resection (ER) is recommended for patients with negligible risk of ESCC-related mortality. In fact, a main cause of death in patients underwent ER is not ESCC. We thus aimed to clarify the predictors for early and late mortality among patients underwent ER of ESCC between 2005 and 2018 at our institution. In this retrospective cohort study, we investigated the prognosis and predictors of early and late mortality with the cutoff value of 3 years. We enrolled 407 patients with a median 69 months follow-up. The 5-year overall survival and disease-specific survival, an indicator of ESCC-related mortality, were 83.4% and 98.4%, respectively. In multivariate Cox analyses, Eastern Cooperative Oncology Group performance status (ECOG-PS), consisting of six grades by a patient's level of activity, ≥ 2 was a predictor for early and late morality [hazard ratio (HR), 7.21 (P = 0.007) and 15.62 (P = 0.021), respectively]. Charlson comorbidity index (CCI), which is an index for predicting mortality by comorbid conditions, ≥ 2 was also a predictor for both mortality [HR, 2.97 (P = 0.017) and 1.90 (P = 0.019), respectively]. However, age was a predictor only for late mortality [HR, 3.08 (P = 0.010) in 80-84 years and 8.38 (P < 0.001) in ≥ 85 years]. Considering the predictive ability for early mortality, we propose that ECOG-PS and/or CCI are better indices compared with age in deciding treatment strategy after ER for ESCC.

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Section: Outcome Measuresmentioning

confidence: 99%

Predictors of Early and Late Mortality after Endoscopic Resection for Esophageal Squamous Cell Carcinoma

Ogata

Hatta

Koike

et al. 2021

Tohoku J. Exp. Med.

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“…A recent study identified the Charlson comorbidity index (CCI) as being a significant prognostic factor in elderly patients who underwent ER for SESCC. 78 In patients who underwent ESD for EGC, the American Society of Anesthesiologists Physical Status (ASA-PS), 99 CCI, 60,100 Eastern Cooperative Oncology Group Performance Status (ECOG-PS), 100 and prognostic nutritional index (PNI) 100,101 were identified as useful prognostic indicators; however, the attained results were not consistent across the studies, 32,60,[99][100][101] so more research is likely warranted. Furthermore, these commonly used unidimensional measures cannot fully do justice to the heterogeneity of elderly patients.…”

Section: Assessment Of Physical Condition In Elderly Patients With Eamentioning

confidence: 99%

Management following endoscopic resection in elderly patients with early‐stage upper gastrointestinal neoplasia

Hatta

Gotoda

Koike

et al. 2020

Digestive Endoscopy

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With the ongoing increase in the aging population in Japan, the number of elderly patients among the total population with upper gastrointestinal (GI) neoplasia has also been increasing. As elderly patients present unique age‐related variations in their physical condition, the therapeutic approach for upper GI neoplasia should be differentiated between elderly and nonelderly patients. According to the existing guidelines, additional treatment is the standard therapy in patients who undergo endoscopic resection (ER) with a possible risk of lymph node metastasis (LNM) for upper GI neoplasia. However, due to the relatively low rate of LNM, applying additional treatment in all elderly patients may be excessive. Although additional treatment has the advantage of reducing cancer‐specific mortality, its disadvantages include deteriorated quality of life, complications, and mortality in surgery. In patients with early gastric cancer, we propose treatment decisions be made using a risk‐scoring system for LNM and upon considering the physical condition of the patient after ER with curability C‐2. In those with superficial esophageal squamous cell carcinoma with a possible risk of LNM after ER, selective chemoradiotherapy may be a less‐invasive treatment option, although the present standard treatment is esophagectomy. When considering the treatment decision, achieving a “cure” of the tumor has been regarded as critical. However, as the main cause of mortality in elderly patients with ER for upper GI neoplasia is noncancer‐related death, both achieving a “cure” and also a good level of “care” is important in the management of elderly patients.

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“…80 In elderly patients with gastric cancer, it is necessary to evaluate not only the risk for LNM but also the condition of the patients because heterogeneity in the aging process leads to a diverse range of age-related declines in health and physical status among elderly patients. To date, several indices for evaluating the condition of patients, such as prognostic nutritional index, 81,82 Charlson comorbidity index, 81,83 and American Society of Anesthesiologists' Physical Status, 84,85 have been reported as indicators for the prognosis in patients with EGCs. However, some reports have shown conflicting results.…”

Section: Management After Noncurative Resectionmentioning

confidence: 99%

“…However, some reports have shown conflicting results. 81,[83][84][85][86] Therefore, for deciding treatment strategy in elderly patients with noncurative resection of ESD for EGCs, the establishment of a reliable tool for predicting the prognosis is demanded.…”

Section: Management After Noncurative Resectionmentioning

confidence: 99%

A Recent Argument for the Use of Endoscopic Submucosal Dissection for Early Gastric Cancers

et al. 2020

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Endoscopic submucosal dissection (ESD) has become the standard treatment method for early gastric cancers (EGCs) due to the negligible risk for lymph node metastasis (LNM) in Eastern Asian countries. According to the guidelines, the curability of EGC after endoscopic resection was classified into three groups: curative resection, expanded curative resection, and noncurative resection. In Eastern Asian countries, a structured follow-up schedule is needed for patients undergoing curative resection and expanded curative resection. Conversely, in Western countries, additional surgery may be recommended for some patients undergoing expanded curative resection (ulcerated, undifferentiated, or slight submucosal invasion) due to the potential risk for LNM, even though specimens of ESD and surgery may not be handled with the same methodology as that used in Japan, which may lead to this slightly higher risk. In noncurative resection, additional surgery is the standard method after ESD because of the risk for LNM. However, in elderly patients and/or those with severe underlying diseases, the advantages and disadvantages of additional surgery should be considered when selecting a post-ESD treatment strategy for patients undergoing noncurative resection. Risk-scoring systems for LNM may facilitate clinical decisions for these patients. However, it should be noted that when recurrence was detected in patients who were followed up with no additional treatment after ESD with noncurative resection, most of them had a poor prognosis. To select an appropriate treatment method, especially in elderly patients undergoing ESD with noncurative resection, a new tool for evaluating the condition of patients should be established. (Gut Liver 2020;14:412-422 ) This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Long-term outcome of endoscopic submucosal dissection for early gastric cancer in patients with severe comorbidities: a comparative propensity score analysis

Cited by 29 publications

References 31 publications

Predictors of Early and Late Mortality after Endoscopic Resection for Esophageal Squamous Cell Carcinoma

Predictors of Early and Late Mortality after Endoscopic Resection for Esophageal Squamous Cell Carcinoma

Management following endoscopic resection in elderly patients with early‐stage upper gastrointestinal neoplasia

A Recent Argument for the Use of Endoscopic Submucosal Dissection for Early Gastric Cancers

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