Waku Hatta1, Takuji Gotoda2, Tsuneo Oyama3, Noboru Kawata4, Akiko Takahashi3, Yoshikazu Yoshifuku5, Shu Hoteya6, Masahiro Nakagawa7, Masaaki Hirano8, Mitsuru Esaki9, Mitsuru Matsuda10, Ken Ohnita11, Kohei Yamanouchi12, Motoyuki Yoshida13, Osamu Dohi14, Jun Takada15, Keiko Tanaka16, Shinya Yamada17, Tsuyotoshi Tsuji18, Hirotaka Ito19, Yoshiaki Hayashi20, Naoki Nakaya21, Tomohiro Nakamura21, Tooru Shimosegawa1. 1. Department of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. 2. Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan. 3. Division of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan. 4. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan. 5. Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. 6. Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan. 7. Department of Endoscopy, Hiroshima City Hospital, Hiroshima, Japan. 8. Department of Internal Medicine, Niigata Prefectural Central Hospital, Joetsu, Japan. 9. Department of Gastroenterology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan. 10. Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan. 11. Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan. 12. Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan. 13. Department of Gastroenterology and Endocrinology and Metabolism, Nara Medical University, Nara, Japan. 14. Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 15. Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan. 16. Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan. 17. Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan. 18. Department of Gastroenterology, Akita City Hospital, Akita, Japan. 19. Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan. 20. Division of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan. 21. Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Sendai, Japan.
Abstract
OBJECTIVES: Although radical surgery is recommended for patients not meeting the curative criteria for endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) because of the potential risk of lymph node metastasis (LNM), this recommendation may be overestimated and excessive. We aimed to establish a simple scoring system for decision making after ESD. METHODS: This multicenter retrospective study consisted of two stages. First, the risk-scoring system for LNM was developed using multivariate logistic regression analysis in 1,101 patients who underwent radical surgery after having failed to meet the curative criteria for ESD of EGC. Next, the system was internally validated by survival analysis in another 905 patients who also did not meet the criteria and did not receive additional treatment after ESD. RESULTS: In the development stage, based on accordant regression coefficients, five risk factors for LNM were weighted with point values: three points for lymphatic invasion and 1 point each for tumor size >30 mm, positive vertical margin, venous invasion, and submucosal invasion ≥500 μm. Then, the patients were categorized into three LNM risk groups: low (0-1 point: 2.5% risk), intermediate (2-4 points: 6.7%), and high (5-7 points: 22.7%). In the validation stage, cancer-specific survival differed significantly among these groups (99.6, 96.0, and 90.1%, respectively, at 5 years; P<0.001). The C statistic of the system for cancer-specific mortality was 0.78. CONCLUSIONS: This scoring system predicted cancer-specific survival in patients who did not meet the curative criteria after ESD for EGC. ESD without additional treatment may be an acceptable option for patients at low risk.
OBJECTIVES: Although radical surgery is recommended for patients not meeting the curative criteria for endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) because of the potential risk of lymph node metastasis (LNM), this recommendation may be overestimated and excessive. We aimed to establish a simple scoring system for decision making after ESD. METHODS: This multicenter retrospective study consisted of two stages. First, the risk-scoring system for LNM was developed using multivariate logistic regression analysis in 1,101 patients who underwent radical surgery after having failed to meet the curative criteria for ESD of EGC. Next, the system was internally validated by survival analysis in another 905 patients who also did not meet the criteria and did not receive additional treatment after ESD. RESULTS: In the development stage, based on accordant regression coefficients, five risk factors for LNM were weighted with point values: three points for lymphatic invasion and 1 point each for tumor size >30 mm, positive vertical margin, venous invasion, and submucosal invasion ≥500 μm. Then, the patients were categorized into three LNM risk groups: low (0-1 point: 2.5% risk), intermediate (2-4 points: 6.7%), and high (5-7 points: 22.7%). In the validation stage, cancer-specific survival differed significantly among these groups (99.6, 96.0, and 90.1%, respectively, at 5 years; P<0.001). The C statistic of the system for cancer-specific mortality was 0.78. CONCLUSIONS: This scoring system predicted cancer-specific survival in patients who did not meet the curative criteria after ESD for EGC. ESD without additional treatment may be an acceptable option for patients at low risk.
Authors: H Isomoto; S Shikuwa; N Yamaguchi; E Fukuda; K Ikeda; H Nishiyama; K Ohnita; Y Mizuta; J Shiozawa; S Kohno Journal: Gut Date: 2008-11-10 Impact factor: 23.059
Authors: Matthew Banks; David Graham; Marnix Jansen; Takuji Gotoda; Sergio Coda; Massimiliano di Pietro; Noriya Uedo; Pradeep Bhandari; D Mark Pritchard; Ernst J Kuipers; Manuel Rodriguez-Justo; Marco R Novelli; Krish Ragunath; Neil Shepherd; Mario Dinis-Ribeiro Journal: Gut Date: 2019-07-05 Impact factor: 23.059
Authors: Ji Eun Na; Hyuk Lee; Yang Won Min; Byung-Hoon Min; Jun Haeng Lee; Poong-Lyul Rhee; Kyoung-Mee Kim; Jae J Kim Journal: J Cancer Res Clin Oncol Date: 2021-03-05 Impact factor: 4.553