Shinya Yamada1, Waku Hatta2, Tooru Shimosegawa2, Kohei Takizawa3, Tsuneo Oyama4, Noboru Kawata3, Akiko Takahashi4, Shiro Oka5, Shu Hoteya6, Masahiro Nakagawa7, Masaaki Hirano8, Mitsuru Esaki9, Mitsuru Matsuda10, Naoki Nakaya11, Takuji Gotoda12. 1. Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan. 2. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. 3. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan. 4. Division of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano, 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 Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Sendai, Japan. 12. Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Abstract
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.
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.