Waku Hatta1, Takuji Gotoda2, Tsuneo Oyama3, Noboru Kawata4, Akiko Takahashi3, Shiro Oka5, Shu Hoteya6, Masahiro Nakagawa7, Masaaki Hirano8, Mitsuru Esaki9,10, Mitsuru Matsuda11, Ken Ohnita12, Ryo Shimoda13, Motoyuki Yoshida14, Osamu Dohi15, Jun Takada16, Keiko Tanaka17, Shinya Yamada18, Tsuyotoshi Tsuji19, Hirotaka Ito20, Hiroyuki Aoyagi21, Tomohiro Nakamura22, Naoki Nakaya22, Tooru Shimosegawa1, Atsushi Masamune1. 1. Division 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. takujigotoda@yahoo.co.jp. 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. Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan. 10. Department of Gastroenterology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan. 11. Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan. 12. Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan. 13. Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan. 14. Department of Gastroenterology and Endocrinology and Metabolism, Nara Medical University, Nara, Japan. 15. Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 16. Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan. 17. Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan. 18. Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan. 19. Department of Gastroenterology, Akita City Hospital, Akita, Japan. 20. Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan. 21. Division of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan. 22. Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Sendai, Japan.
Abstract
BACKGROUND: When a lesion does not meet the curative criteria of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), referred to as non-curative resection or curability C-2 in the guidelines, an additional surgery is the standard therapy because of the risk of lymph node metastasis (LNM). OBJECTIVE: This study aimed to identify high-risk patients for recurrence after additional surgery for curability C-2 ESD of EGC. METHODS: This multicenter retrospective cohort study enrolled 1064 patients who underwent additional surgery after curability C-2 ESD for EGC. We evaluated the recurrence rate and the risk factors for recurrence after additional surgery in these patients. RESULTS: The 5-year recurrence rate after additional surgery was 1.3%. Multivariate Cox analysis revealed that the independent risk factors for recurrence after additional surgery were LNM (hazard ratio [HR] 32.47; p < 0.001) and vascular invasion (HR 4.75; p = 0.014). Moreover, patients with both LNM and vascular invasion had a high rate of recurrence after additional surgery (24.6% in 5 years), with a high HR (119.32) compared with those with neither LNM nor vascular invasion. Among patients with no vascular invasion, a high rate of recurrence was observed in those with N2/N3 disease according to the American Joint Committee on Cancer TNM staging system (27.3% in 5 years), in contrast with no recurrence in those with N1 disease. CONCLUSIONS: Patients with both LNM (N1-N3) and vascular invasion, as well as those with N2/N3 disease but no vascular invasion, would be candidates for adjuvant chemotherapy after additional surgery for curability C-2 ESD of EGC.
BACKGROUND: When a lesion does not meet the curative criteria of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), referred to as non-curative resection or curability C-2 in the guidelines, an additional surgery is the standard therapy because of the risk of lymph node metastasis (LNM). OBJECTIVE: This study aimed to identify high-risk patients for recurrence after additional surgery for curability C-2 ESD of EGC. METHODS: This multicenter retrospective cohort study enrolled 1064 patients who underwent additional surgery after curability C-2 ESD for EGC. We evaluated the recurrence rate and the risk factors for recurrence after additional surgery in these patients. RESULTS: The 5-year recurrence rate after additional surgery was 1.3%. Multivariate Cox analysis revealed that the independent risk factors for recurrence after additional surgery were LNM (hazard ratio [HR] 32.47; p < 0.001) and vascular invasion (HR 4.75; p = 0.014). Moreover, patients with both LNM and vascular invasion had a high rate of recurrence after additional surgery (24.6% in 5 years), with a high HR (119.32) compared with those with neither LNM nor vascular invasion. Among patients with no vascular invasion, a high rate of recurrence was observed in those with N2/N3 disease according to the American Joint Committee on CancerTNM staging system (27.3% in 5 years), in contrast with no recurrence in those with N1 disease. CONCLUSIONS:Patients with both LNM (N1-N3) and vascular invasion, as well as those with N2/N3 disease but no vascular invasion, would be candidates for adjuvant chemotherapy after additional surgery for curability C-2 ESD of EGC.