Long-term prognosis of expanded-indication differentiated-type early gastric cancer treated with endoscopic submucosal dissection or surgery using propensity score analysis

Fukunaga, Shusei; Nagami, Yasuaki; Shiba, Masatsugu; Ominami, Masaki; Tanigawa, Tetsuya; Yamagami, Hirokazu; Tanaka, Hiroaki; Muguruma, Kazuya; Watanabe, Toshio; Tominaga, Kazunari; Fujiwara, Yasuhiro; Ohira, Masaichi; Hirakawa, Kosei; Arakawa, Tetsuo

doi:10.1016/j.gie.2016.06.049

Cited by 92 publications

(79 citation statements)

References 45 publications

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“…Categorical variables are presented as a mean ± standard deviation (SD) and were evaluated using the Chi-squared or the Fisher exact test, and continuous variables are presented as the median plus interquartile range (IQR) using unpaired t tests. A propensity score matching analysis was performed to reduce the effects of selection bias and potential confounding factors between each group by mathematically refashioning an observational study into a randomized study [18][19][20][21][22]. A propensity score-matched cohort was created by matching ASA-PS 1/2 and ASA-PS 3 patients (a 1:1 match) by using a greedy matching technique.…”

Section: Discussionmentioning

confidence: 99%

“…Absolute standardized differences (ASD) were calculated for evaluating the matching effectiveness. Additionally, the inverse probability of treatment weighting (IPTW) method was performed to evaluate the sensitivity of the results by estimating propensity scores used to weigh individual observations [22][23][24]. The IPTW method, which is one of the approaches used to adjust the confounding factor, has the advantage of evaluating causal effects without reducing sample size.…”

Section: Discussionmentioning

confidence: 99%

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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

et al. 2018

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Background Recently, endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) has been performed on patients with severe comorbidities because it is less invasive, although little is known regarding long-term outcomes. This study aimed to assess the long-term outcomes of ESD for patients with severe and non-severe comorbidities. Methods We enrolled 1081 patients who underwent ESD for EGC between February 2004 and June 2013. Based on the American Society of Anesthesiologists Physical Status (ASA-PS) classification, we defined patients with severe and nonsevere comorbidities as ASA-PS 3 and 1/2, respectively. We retrospectively compared the overall survival, risk factors for mortality, and adverse events between these two groups using propensity score matching and inverse probability of treatment weighting. Results A total of 488 patients met the eligibility criteria. After matching, the ASA-PS 3 group showed a significantly shorter survival than the ASA-PS 1/2 group (5-year overall survival rate, 79.1 vs. 87.7%; p < 0.01). In addition, only the ASA-PS 3 group had a significant risk factor for mortality using both the Cox analysis [hazard ratio (HR), 2.56; 95% confidence interval (CI) 1.18-5.52; p = 0.02] and the IPTW method (HR, 3.14; 95% CI 1.91-5.14; p < 0.01). There was no significant difference in adverse events after matching between the two groups (p = 0.21). Conclusions The long-term outcome of gastric ESD for patients with severe comorbidities was worse than for those with non-severe comorbidities. Further studies will be necessary to determine if ESD is truly warranted in these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…Third, after the cut-off value had been determined, we evaluated the incidence of stricture formation using the IPTW method with propensity scoring. 21,22,24,25 Selection bias can persist in retrospective studies, because the relationship between stricture formation and the circumferential mucosal defect may be affected by confounding factors, including age, gender, and clinical characteristics. 23 An IPTW method based on propensity scoring, which can be used without reducing the sample size, was used to assess the sensitivity of the results and to evaluate statistically causal effects that were independent of the confounding effects.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the inverse probability of treatment weighting (IPTW) method based on propensity scoring was used. [21][22][23][24][25] We adjusted for confounding factors by using the estimated propensity scores to assign weights to the data. Analyses involving IPTW linear regressions for stricture formation were carried out.…”

Section: Statistical Analysesmentioning

confidence: 99%

Prediction of esophageal stricture in patients given locoregional triamcinolone injections immediately after endoscopic submucosal dissection

Nagami

Ominami

Shiba

et al. 2017

Digestive Endoscopy

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“…Surgical resection, especially esophagectomy, has a high mortality rate that often exceeds 2%, with substantial morbidity and no guarantee of curing metastasis [28]. In addition, Fukunaga et al [29] suggested that with or without comorbidities, the difference of surgical technique contributed to long-term survival in patients treated with surgical resection for early gastric cancer. Furthermore, more invasive surgery results in a poorer quality of life, which may influence mortality.…”

Section: Other Treatmentmentioning

confidence: 99%

Endoscopic Submucosal Dissection for Adenocarcinomas of the Esophagogastric Junction

et al. 2018

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Background: Adenocarcinoma of the esophagogastric junction (EGJ) is uncommon in Eastern countries, including Japan, but it is believed that the incidence of EGJ adenocarcinoma will increase in Asia in the future due to the decreasing incidence of Helicobacter pylori infection. Endoscopic submucosal dissection (ESD) is a minimally invasive and curative treatment that allows precise pathological assessment. Summary: Magnifying endoscopy with narrow-band imaging may be useful for differential diagnoses and for delineating the cancer margin of EGJ adenocarcinoma, but subsquamous carcinoma extension, which is the invasion of EGJ adenocarcinoma beneath the normal esophageal squamous epithelium, makes it difficult to detect cancer margins of the oral side in ESD for EGJ adenocarcinoma. Since subsquamous carcinoma extension was reported to be less than 1 cm in most cases, the oral safety margin that is placed 1 cm from the squamocolumnar junction is useful for negative cancerous horizontal margin. A multicenter retrospective study of esophageal adenocarcinoma including EGJ adenocarcinoma showed that mucosal and submucosal cancer within 500 μm from the muscularis mucosa without lymphovascular involvement, a poorly differentiated component, and lesion size over 3 cm were not associated with metastasis. Several retrospective studies about ESD for EGJ adenocarcinoma have suggested feasible short-term and long-term outcomes using curative criteria based on gastric cancer guidelines. Key Messages: ESD would be a good first-line treatment for superficial EGJ adenocarcinoma, including Barrett’s adenocarcinoma. Additional information about the incidence of metastasis would help confirm the indication of ESD for EGJ adenocarcinoma.

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Long-term prognosis of expanded-indication differentiated-type early gastric cancer treated with endoscopic submucosal dissection or surgery using propensity score analysis

Cited by 92 publications

References 45 publications

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

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

Prediction of esophageal stricture in patients given locoregional triamcinolone injections immediately after endoscopic submucosal dissection

Endoscopic Submucosal Dissection for Adenocarcinomas of the Esophagogastric Junction

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