Jun Chul Park1, Yong Kang Lee2, Soon Young Kim2, Yunho Roh3, Kyu Yeon Hahn2, Sung Kwan Shin2, Sang Kil Lee2, Yong Chan Lee2, Hyoung-Il Kim4, Jae-Ho Cheong4, Woo Jin Hyung4, Sung Hoon Noh4. 1. Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. junchul75@yuhs.ac. 2. Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. 3. Department of Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea. 4. Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Abstract
BACKGROUND: The treatment of intramucosal early gastric cancer with undifferentiated-type histologies (UD-EGCs) using endoscopic submucosal dissection (ESD) is controversial. This study aimed to compare the clinical and oncologic long-term outcomes of ESD and surgery for UD-EGCs. METHODS: A prospectively collected database of patients who underwent ESD or surgery between January 2006 and December 2012 was established. Patients who diagnosed with UD-EGC and satisfied the expanded indications of ESD were included. Clinical data from 111 patients treated with ESD and 382 patients underwent surgery were analyzed, and 1-1 propensity score-matched 81 pairs of patients were also compared. RESULTS: In both groups, two-thirds of the UD-EGCs had signet ring cell (SRC)-type histology and about 90% of UD-EGCs were flat or depressed types. The mean size of tumors was smaller in ESD group (9.7 vs. 13.2 mm; P < 0.001). After propensity score-matched, case-matching covariates were not significantly different between the groups. Disease-free survival (DFS) was significantly shorter in the ESD group, but overall survival (OS) was not different between the two groups both in overall comparison (DFS; P < 0.001 and OS; P = 0.078) and propensity score-matched analysis (DFS; P < 0.001 and OS; P = 0.850). According to histologic type, OS of SRC histology was not different between the group, both in overall comparison and propensity score-matched analysis (P = 0.286 and P = 0.210). On the other hands, OS of poorly differentiated adenocarcinoma was significantly shorter in ESD group in overall comparison (P = 0.007), but was not as so in propensity score-matched analysis (P = 0.088). CONCLUSIONS: ESD might be a complementary option for the treatment of UD-EGCs, especially in those with SRC-type histology based on strict expanded indications. Nonetheless, close endoscopic surveillance is required because of a high incidence of intragastric recurrence.
BACKGROUND: The treatment of intramucosal early gastric cancer with undifferentiated-type histologies (UD-EGCs) using endoscopic submucosal dissection (ESD) is controversial. This study aimed to compare the clinical and oncologic long-term outcomes of ESD and surgery for UD-EGCs. METHODS: A prospectively collected database of patients who underwent ESD or surgery between January 2006 and December 2012 was established. Patients who diagnosed with UD-EGC and satisfied the expanded indications of ESD were included. Clinical data from 111 patients treated with ESD and 382 patients underwent surgery were analyzed, and 1-1 propensity score-matched 81 pairs of patients were also compared. RESULTS: In both groups, two-thirds of the UD-EGCs had signet ring cell (SRC)-type histology and about 90% of UD-EGCs were flat or depressed types. The mean size of tumors was smaller in ESD group (9.7 vs. 13.2 mm; P < 0.001). After propensity score-matched, case-matching covariates were not significantly different between the groups. Disease-free survival (DFS) was significantly shorter in the ESD group, but overall survival (OS) was not different between the two groups both in overall comparison (DFS; P < 0.001 and OS; P = 0.078) and propensity score-matched analysis (DFS; P < 0.001 and OS; P = 0.850). According to histologic type, OS of SRC histology was not different between the group, both in overall comparison and propensity score-matched analysis (P = 0.286 and P = 0.210). On the other hands, OS of poorly differentiated adenocarcinoma was significantly shorter in ESD group in overall comparison (P = 0.007), but was not as so in propensity score-matched analysis (P = 0.088). CONCLUSIONS: ESD might be a complementary option for the treatment of UD-EGCs, especially in those with SRC-type histology based on strict expanded indications. Nonetheless, close endoscopic surveillance is required because of a high incidence of intragastric recurrence.
Entities:
Keywords:
ESD; Early gastric cancer; Long-term outcomes; Recurrences; Undifferentiated histology
Authors: Woo Jin Hyung; Sung Hoon Noh; Jun Ho Lee; Jihun J Huh; Ki Hyeok Lah; Seung Ho Choi; Jin Sik Min Journal: Cancer Date: 2002-01-01 Impact factor: 6.860
Authors: K Okada; J Fujisaki; T Yoshida; H Ishikawa; T Suganuma; A Kasuga; M Omae; M Kubota; A Ishiyama; T Hirasawa; A Chino; M Inamori; Y Yamamoto; N Yamamoto; T Tsuchida; Y Tamegai; A Nakajima; E Hoshino; M Igarashi Journal: Endoscopy Date: 2012-01-23 Impact factor: 10.093
Authors: Il Ju Choi; Jun Ho Lee; Young-Il Kim; Chan Gyoo Kim; Soo-Jeong Cho; Jong Yeul Lee; Keun Won Ryu; Byung-Ho Nam; Myeong-Cherl Kook; Young-Woo Kim Journal: Gastrointest Endosc Date: 2014-10-03 Impact factor: 9.427
Authors: Chen Li; Sungsoo Kim; Ji Fu Lai; Sung Jin Oh; Woo Jin Hyung; Won Hyuk Choi; Seung Ho Choi; Zheng Gang Zhu; Sung Hoon Noh Journal: Ann Surg Oncol Date: 2007-11-28 Impact factor: 5.344
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: Chan Hyuk Park; Dong-Hoon Yang; Jong Wook Kim; Jie-Hyun Kim; Ji Hyun Kim; Yang Won Min; Si Hyung Lee; Jung Ho Bae; Hyunsoo Chung; Kee Don Choi; Jun Chul Park; Hyuk Lee; Min-Seob Kwak; Bun Kim; Hyun Jung Lee; Hye Seung Lee; Miyoung Choi; Dong-Ah Park; Jong Yeul Lee; Jeong-Sik Byeon; Chan Guk Park; Joo Young Cho; Soo Teik Lee; Hoon Jai Chun Journal: Clin Endosc Date: 2020-03-30
Authors: Ho Seok Seo; Han Mo Yoo; Yoon Ju Jung; Sung Hak Lee; Jae Myung Park; Kyo Young Song; Eun Sun Jung; Myung-Gyu Choi; Cho Hyun Park Journal: J Gastric Cancer Date: 2020-12-23 Impact factor: 3.720
Authors: Chan Hyuk Park; Dong-Hoon Yang; Jong Wook Kim; Jie-Hyun Kim; Ji Hyun Kim; Yang Won Min; Si Hyung Lee; Jung Ho Bae; Hyunsoo Chung; Kee Don Choi; Jun Chul Park; Hyuk Lee; Min-Seob Kwak; Bun Kim; Hyun Jung Lee; Hye Seung Lee; Miyoung Choi; Dong-Ah Park; Jong Yeul Lee; Jeong-Sik Byeon; Chan Guk Park; Joo Young Cho; Soo Teik Lee; Hoon Jai Chun Journal: Intest Res Date: 2020-10-13