TY - JOUR
T1 - Different risk factors between early and late cancer recurrences in patients without additional surgery after noncurative endoscopic submucosal dissection for early gastric cancer
AU - Yamada, Shinya
AU - Hatta, Waku
AU - Shimosegawa, Tooru
AU - Takizawa, Kohei
AU - Oyama, Tsuneo
AU - Kawata, Noboru
AU - Takahashi, Akiko
AU - Oka, Shiro
AU - Hoteya, Shu
AU - Nakagawa, Masahiro
AU - Hirano, Masaaki
AU - Esaki, Mitsuru
AU - Matsuda, Mitsuru
AU - Nakaya, Naoki
AU - Gotoda, Takuji
N1 - Funding Information:
We thank all members of the EAST Study Group. We thank Hiroyuki Ono (Shizuoka Cancer Center), Naohiko Harada (National Hospital Organization Kyushu Medical Center), Yasumasa Hara (Toyama Prefectural Central Hospital), Ken Ohnita (Nagasaki University Hospital), Ryo Shimoda and Kohei Yamanouchi (Saga Medical School), Motoyuki Yoshida (Nara Medical University), Osamu Dohi (Kyoto Prefectural University of Medicine), Jun Takada (Gifu University Graduate School of Medicine), Keiko Tanaka (Shinshu University School of Medicine), Tsuyotoshi Tsuji (Akita City Hospital), Hirotaka Ito (Osaki Citizen Hospital), and Hiroyuki Aoyagi (Fukui Prefectural Hospital) for the enrollment of patients and data collection. Finally, we thank Norimasa Yoshida and Hideki Fujii (Japanese Red Cross Society Kyoto Daiichi Hospital), and Tomohiro Nakamura (Tohoku Medical Megabank Organization) for their insightful comments.
Publisher Copyright:
© 2019 American Society for Gastrointestinal Endoscopy
PY - 2019/5
Y1 - 2019/5
N2 - 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.
AB - 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.
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U2 - 10.1016/j.gie.2018.11.015
DO - 10.1016/j.gie.2018.11.015
M3 - Article
C2 - 30465769
AN - SCOPUS:85060097824
VL - 89
SP - 950
EP - 960
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
SN - 0016-5107
IS - 5
ER -