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
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) guideline.Endoscopy. 2015; 47: 829-854
- Endoscopic submucosal dissection.Gastrointest Endosc. 2015; 81: 1311-1325
- Japanese gastric cancer treatment guidelines 2014 (ver. 4).Gastric Cancer. 2017; 20: 1-19
- Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer.Dig Endosc. 2016; 28: 3-15
- Gastric cancer treatment guideline.5th ed. Kanehara, Tokyo2018 (in Japanese)
- Is radical surgery necessary in all patients who do not meet the curative criteria for endoscopic submucosal dissection in early gastric cancer? A multicenter retrospective study in Japan.J Gastroenterol. 2017; 52: 175-184
- Clinical outcomes of early gastric cancer patients after noncurative endoscopic submucosal dissection in a large consecutive patient series.Gastric Cancer. 2017; 20: 679-689
- Natural course of noncurative endoscopic resection of differentiated early gastric cancer.Endoscopy. 2012; 44: 1114-1120
- Predictors of lymph node metastasis in patients with non-curative endoscopic resection of early gastric cancer.Surg Endosc. 2015; 29: 1145-1155
- Long-term outcomes after noncurative endoscopic resection of early gastric cancer: the optimal time for additional endoscopic treatment.Gastrointest Endosc. 2018; 87: 1003-1013
- Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications.Gastrointest Endosc. 2011; 74: 485-493
- Long-term prognosis of expanded-indication differentiated-type early gastric cancer treated with endoscopic submucosal dissection or surgery using propensity score analysis.Gastrointest Endosc. 2017; 85: 143-152
- Risk factors for lymph node metastasis and long-term outcomes of patients with early gastric cancer after non-curative endoscopic submucosal dissection.Surg Endosc. 2017; 31: 1607-1616
- Clinical outcomes of noncurative endoscopic submucosal dissection with negative resected margins for gastric cancer.Gastrointest Endosc. 2017; 85: 1218-1224
- Effect of additional surgery after noncurative endoscopic submucosal dissection for early gastric cancer.Endosc Int Open. 2016; 4: E24-E29
- Clinicopathological outcomes of patients with early gastric cancer after non-curative endoscopic submucosal dissection.Digestion. 2016; 93: 53-58
- Clinical outcomes of early gastric cancer with lymphovascular invasion or positive vertical resection margin after endoscopic submucosal dissection.Surg Endosc. 2015; 29: 2583-2589
- Significance of long-term follow-up of early gastric cancer.Ann Surg Oncol. 2006; 13: 363-369
- Tumor recurrence and its timing following curative resection of early gastric carcinoma.Anticancer Res. 2003; 23: 3499-3503
- Recurrence after curative resection of early gastric cancer.Ann Surg Oncol. 2010; 17: 448-454
- Japanese classification of gastric carcinoma: 3rd English edition.Gastric Cancer. 2011; 14: 101-112
- Additional surgery for non-curative resection after endoscopic submucosal dissection for gastric cancer: a retrospective analysis of 200 cases.Surg Today. 2017; 47: 202-209
- Management of early gastric cancer that meet the indication for radical lymph node dissection following endoscopic resection: a retrospective cohort analysis.BMC Surg. 2017; 17: 72
- Surgical outcomes and clinicopathological characteristics of patients who underwent potentially noncurative endoscopic resection for gastric cancer: a report of a single-center experience.Gastroenterol Res Pract. 2013; 2013: 427405
- A Scoring system to stratify curability after endoscopic submucosal dissection for early gastric cancer: “eCura system”.Am J Gastroenterol. 2017; 112: 874-881
- Significance of lymphatic invasion on regional lymph node metastasis in early gastric cancer using LYVE-1 immunohistochemical analysis.Am J Clin Pathol. 2007; 127: 82-88
- Relationship between hematogenic metastasis of gastric cancer and the maximum extent of venous invasion by cancer cells in the gastric wall.Hepatogastroenterology. 1995; 42: 660-665
- Vascular invasion and potential for tumor angiogenesis and metastasis in gastric carcinoma.Surgery. 2000; 128: 408-416
- Experimental study of lymphogenous peritoneal cancer dissemination: migration of fluorescent-labelled tumor cells in a rat model of mesenteric lymph vessel obstruction.J Exp Clin Cancer Res. 2000; 19: 211-217
- Liver metastasis in gastric cancer with particular reference to lymphatic advancement.Gastric Cancer. 2001; 4: 150-155
- Metachronous liver metastasis from early gastric cancer.J Gastrointest Surg. 2012; 16: 837-841
- Recurrence of early gastric cancer. Follow-up of 1475 patients and review of the Japanese literature.Cancer. 1993; 72: 3174-3178
- Is D2 lymph node dissection necessary for early gastric cancer?.Ann Surg Oncol. 2002; 9: 401-405
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.
- Full-Text
- Preview
