Predictive Factors for Metachronous Recurrence of Early Gastric Cancer After Endoscopic Treatment

Abstract

Since endoscopic treatment has been evaluated and become established as treatment for early gastric cancer, metachronous recurrence has become a major problem. In this report, predictive factors for recurrence were studied using the Kaplan-Meier method and Cox's proportional hazards regression model in 76 patients who received endoscopic treatment. There were 48 men and 28 women age 69.6 +/- 8.3 years (mean +/- standard deviation), 5 of whom had synchronous multiple lesions and 71 who had a single lesion found during the initial endoscopic treatment. In all patients, periodic follow-ups were performed by endoscopy for more than 2 years after treatment. Helicobacter pylori infection was assessed in 55 of the 76 patients, and proved positive in 43 and negative in 12. Metachronous recurrence was detected significantly more frequently in patients whose synchronous multiple lesions were found during the initial treatment. In addition, age affected the recurrence positively. However, gender and H. pylori infection had no significant relationship with metachronous recurrence.

Higher Methylation Levels in Gastric Mucosae Significantly Correlate with Higher Risk of Gastric Cancers

“…The presence of individuals with a very high risk is indicated by the fact that cases with multiple gastric cancers have a much higher chance of developing another gastric cancer than those of cases with a single gastric cancer (8,9). To identify these people, markers for multiple gastric cancers, such as gastric atrophy (10), microsatellite instability in cancers (11), and expression of brain-type glycogen phosphorylase in noncancerous gastric mucosae (12), have been developed.…”

BGP expression in gastric biopsies may predict the development of new lesions after local treatment for early gastric cancer

“…How- ever, the application of molecular genetics in the screening and surveillance of patients for gastric carcinoma is still in its infancy. Arima et al [8] reported that metachronous recurrence was found in 6 of 76 endoscopically treated patients, and it was detected significantly more frequently in patients whose synchronous multiple lesions were found during the initial treatment; they stressed the importance of the detection of gastric mucosal recurrence by frequent periodic endoscopic examinations during the follow-up period after the endoscopic treatment. Early detection of the metachronous cancer is beneficial for the subsequent treatment of the new lesion, for which minimally invasive therapy, including EMR, can be used.…”

“…Therefore, a reliable predictive indicator of patients with a high risk of metachronous recurrence is very important for determining the schedule of endoscopic follow-up after the initial endoscopic treatment. Because metachronous recurrence was detected significantly more frequently in patients with synchronous multiple lesions [2,3,8], a predictive indicator for metachronous recurrence would correspond with the indicator for synchronous multiple gastric carcinoma. Wittekind et al [14] analyzed 61 patients with synchronous gastric carcinoma from among 1664 patients, and suggested that multiple primary tumors arose from precancerous conditions leading to similar genetic alterations.…”

“…We agree with both the opinion that "the surgeon is required to resect the area including the F-line at the time of distal gastrectomy so as not to leave another cancer in the gastric remnant" [15] and the opinion that "the treatment of multiple gastric cancer does not require extended operative procedure, and EMR may be indicated if each lesion fits the criteria for treatment and careful follow-up is ensured" [31]. The important thing is to have a good predictor for metachronous recurrence after local treatment [8,25]. The present study demonstrated that BGP-IM was detected even in the stomachs with endoscopic atrophic gastritis without any malignant lesion, suggesting that BGP-IM was not a pathological entity which was associated with the change of a carcinogenic microenvironment in the gastric mucosa.…”

“…These treatments, however, incur increasing risks of missing the coexistence of accessory (microscopic) carcinomas and/or developing new cancers in the remnant stomach [6][7][8][9].…”