Background and Aims
Cancer recurrence is observed in some patients without additional radical surgery
after endoscopic submucosal dissection (ESD) that does not fulfill the curability
criteria for early gastric cancer (EGC), categorized as “noncurative resection” or
“curability C-2” in the guidelines. However, time to cancer recurrence is different
in such patients. Thus, we aimed to identify the risk factors of early and late cancer
recurrences in these patients.
Methods
Between 2000 and 2011, this multicenter study analyzed 905 patients who were followed
up without additional radical surgery after ESD for EGC categorized as curability
C-2. We evaluated the risk factors for early and late cancer recurrences, separately,
after ESD. The cut-off value was defined at 2 years.
Results
Time to cancer recurrence in the enrolled patients showed a bimodal pattern, and the
5-year cancer recurrence rate was 3.2%. Multivariate Cox analyses revealed that lymphatic
invasion (hazard ratio [HR], 8.56; P = .003) was the sole independent risk factor for early cancer recurrence. Regarding
late cancer recurrence, vascular invasion (HR, 4.50; P = .039) was an independent risk factor, and lymphatic invasion tended to be a risk
factor (HR, 3.63; P = .069).
Conclusions
This multicenter study with a large cohort demonstrated that lymphatic invasion is
mainly associated with early cancer recurrence; however, vascular invasion was a risk
factor only for late recurrence in patients without additional treatment after ESD
for EGC categorized as curability C-2. This finding may contribute to decision making
for treatment strategies after ESD, especially for patients with a relatively short
life expectancy.
Abbreviations:
CI (confidence interval), EAST (Establishment of Accommodation of Early Stomach Cancer Treatment), EGC (early gastric cancer), HR (hazard ratio), IQR (interquartile range), LNM (lymph node metastasis), SM2 (tumor invasion into the submucosa ≥500 μm from the muscularis mucosa), VM (vertical margin)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: November 19, 2018
Accepted:
November 11,
2018
Received:
July 26,
2018
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
© 2019 by the American Society for Gastrointestinal Endoscopy
ScienceDirect
Access this article on ScienceDirectLinked Article
- Different risk factors between early and late cancer recurrences in patients without additional surgery after noncurative endoscopic submucosal dissection for early gastric cancerGastrointestinal EndoscopyVol. 92Issue 1
- PreviewWe have read with great interest the article by Yamada et al1 on the risk factors of early and late cancer recurrences in patients without additional surgery after endoscopic submucosal dissection for early gastric cancer categorized as curability C-2. In that study, the authors reported that lymphatic invasion was the sole independent risk factor for early cancer recurrence. Regarding late cancer recurrence, vascular invasion was an independent risk factor. They also found that time to cancer recurrence showed a bimodal pattern and that the 5-year cancer recurrence rate was 3.2%. We congratulate and applaud the authors on their interesting and important work on this topic, but we have some concerns about the study.
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