Jie-Hyun Kim1, Young-Il Kim2, Ji Yong Ahn3, Woon Geon Shin4, Hyo-Joon Yang5, Su Youn Nam6, Byung-Hoon Min7, Jae-Young Jang8, Joo Hyun Lim9, Wan Sik Lee10, Bong Eun Lee11, Moon Kyung Joo12, Jae Myung Park13, Hang Lak Lee14, Tae-Geun Gweon15, Moo In Park16, Jeongmin Choi17, Chung Hyun Tae18, Young-Woo Kim2, Boram Park19, Il Ju Choi20. 1. Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 2. Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 10408, South Korea. 3. Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. 4. Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea. 5. Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. 6. Gastroenterology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea. 7. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 8. Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea. 9. Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea. 10. Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea. 11. Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea. 12. Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea. 13. Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea. 14. Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea. 15. Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Incheon, Korea. 16. Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea. 17. Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea. 18. Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea. 19. Biostatistics Collaboration Team, Research Core Center, Research Institute, National Cancer Center, Goyang, Korea. 20. Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 10408, South Korea. cij1224@ncc.re.kr.
Abstract
BACKGROUND: Undifferentiated-type early gastric cancer (UD EGC) shows lower curative resection rates after endoscopic submucosal dissection (ESD). Additional surgery is recommended after non-curative resection. We evaluated the long-term outcomes of ESD followed by additional surgery after non-curative resection in UD EGC compared to those for surgery as initial treatment. METHODS: We reviewed 1139 UD EGC patients who underwent ESD at 18 hospitals and 1956 patients who underwent surgery at two hospitals between February 2005 and May 2015. We enrolled 636 patients with non-curative ESD and 1429 surgery subjects beyond the curative ESD criteria. Among them, 133 patients with additional surgery after ESD (ESD + OP group) and 252 patients without additional surgery (ESD-only group) were matched 1:1 using propensity scores to patients with surgery as initial treatment (surgery group). Overall survival (OS) and recurrence-free survival (RFS) were compared. RESULTS: Signet ring cell carcinoma and poorly differentiated adenocarcinoma (PDA) were observed in 939 and 1126 cases, respectively. OS was significantly longer in the surgery group than in the ESD + OP group, especially for PDA. However, RFS was shorter in the ESD-only group than those in the ESD + OP and surgery groups. RFS did not differ significantly between the ESD + OP and surgery groups. Compared to the surgery group, the ESD-only and ESD + OP groups had an overall hazard ratio for RFS of 3.58 (95% confidence interval 1.44-8.88) and 0.46 (0.10-2.20), respectively. CONCLUSIONS: ESD followed by additional surgery after non-curative resection showed comparable cancer-specific outcomes to initial surgery in UD EGC.
BACKGROUND: Undifferentiated-type early gastric cancer (UD EGC) shows lower curative resection rates after endoscopic submucosal dissection (ESD). Additional surgery is recommended after non-curative resection. We evaluated the long-term outcomes of ESD followed by additional surgery after non-curative resection in UD EGC compared to those for surgery as initial treatment. METHODS: We reviewed 1139 UD EGC patients who underwent ESD at 18 hospitals and 1956 patients who underwent surgery at two hospitals between February 2005 and May 2015. We enrolled 636 patients with non-curative ESD and 1429 surgery subjects beyond the curative ESD criteria. Among them, 133 patients with additional surgery after ESD (ESD + OP group) and 252 patients without additional surgery (ESD-only group) were matched 1:1 using propensity scores to patients with surgery as initial treatment (surgery group). Overall survival (OS) and recurrence-free survival (RFS) were compared. RESULTS: Signet ring cell carcinoma and poorly differentiated adenocarcinoma (PDA) were observed in 939 and 1126 cases, respectively. OS was significantly longer in the surgery group than in the ESD + OP group, especially for PDA. However, RFS was shorter in the ESD-only group than those in the ESD + OP and surgery groups. RFS did not differ significantly between the ESD + OP and surgery groups. Compared to the surgery group, the ESD-only and ESD + OP groups had an overall hazard ratio for RFS of 3.58 (95% confidence interval 1.44-8.88) and 0.46 (0.10-2.20), respectively. CONCLUSIONS: ESD followed by additional surgery after non-curative resection showed comparable cancer-specific outcomes to initial surgery in UD EGC.