A Prediction Model Based on the Risk Factors Associated with Pathological Upgrading in Patients with Early-Stage Gastric Neoplasms Diagnosed by Endoscopic Forceps Biopsy
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: The discrepancies between the diagnosis of preoperative endoscopic forceps biopsy (EFB) and endoscopic submucosal dissection (ESD) in patients with early gastric neoplasm (EGN) exist objectively. Among them, pathological upgrading directly influences the accuracy and appropriateness of clinical decisions. The aims of this study were to investigate the risk factors for the discrepancies, with a particular focus on pathological upgrading and to establish a prediction model for estimating the risk of pathological upgrading after EFB. Methods: We retrospectively collected the records of 978 patients who underwent ESD from December 1, 2017 to July 31, 2021 and who had a final histopathology determination of EGN. A nomogram to predict the risk of pathological upgrading was constructed after analyzing subgroup differences among the 901 lesions enrolled. Results: The ratio of pathological upgrading was 510 of 953 (53.5%). Clinical, laboratorial and endoscopic characteristics were analyzed using univariable and binary multivariable logistic regression analyses. A nomogram was constructed by including age, history of chronic atrophic gastritis, symptoms of digestive system, blood high density lipoprotein concentration, macroscopic type, pathological diagnosis of EFB, uneven surface, remarkable redness, and lesion size. The C-statistics were 0.804 (95% confidence interval, 0.774 to 0.834) and 0.748 (95% confidence interval, 0.664 to 0.832) in the training and validation set, respectively. We also built an online webserver based on the proposed nomogram for convenient clinical use. Conclusions: The clinical value of identifying the preoperative diagnosis of EGN lesions is limited when using EFB separately. We have developed a nomogram that can predict the probability of pathological upgrading with good calibration and discrimination value.
Abstract
Background/Aims: The discrepancies between the diagnosis of preoperative endoscopic forceps biopsy (EFB) and endoscopic submucosal dissection (ESD) in patients with early gastric neoplasm (EGN) exist objectively. Among them, pathological upgrading directly influences the accuracy and appropriateness of clinical decisions. The aims of this study were to investigate the risk factors for the discrepancies, with a particular focus on pathological upgrading and to establish a prediction model for estimating the risk of pathological upgrading after EFB. Methods: We retrospectively collected the records of 978 patients who underwent ESD from December 1, 2017 to July 31, 2021 and who had a final histopathology determination of EGN. A nomogram to predict the risk of pathological upgrading was constructed after analyzing subgroup differences among the 901 lesions enrolled. Results: The ratio of pathological upgrading was 510 of 953 (53.5%). Clinical, laboratorial and endoscopic characteristics were analyzed using univariable and binary multivariable logistic regression analyses. A nomogram was constructed by including age, history of chronic atrophic gastritis, symptoms of digestive system, blood high density lipoprotein concentration, macroscopic type, pathological diagnosis of EFB, uneven surface, remarkable redness, and lesion size. The C-statistics were 0.804 (95% confidence interval, 0.774 to 0.834) and 0.748 (95% confidence interval, 0.664 to 0.832) in the training and validation set, respectively. We also built an online webserver based on the proposed nomogram for convenient clinical use. Conclusions: The clinical value of identifying the preoperative diagnosis of EGN lesions is limited when using EFB separately. We have developed a nomogram that can predict the probability of pathological upgrading with good calibration and discrimination value.
참고문헌 (58)
- Nagtegaal ID, "The 2019 WHO classification of tumours of the digestive system", Histopathology, 76, pp.182~188 (2020)
- Huang D, "2019 updates of the WHO classification of the digestive system tumors, part : epithelial neoplasms in gastrointestinal tract", Zhonghua Bing Li Xue Za Zhi, 49, pp.209~213 (2020)
- Schlemper RJ, "The Vienna classification of gastrointestinal epithelial neoplasia", Gut, 47, pp.251~255 (2000)
- Marcos P, "Endoscopic grading of gastric intestinal metaplasia on risk assessment for early gastric neoplasia : can we replace histology assessment also in the West?", Gut, 69, pp.1762~1768 (2020)
- Ono H, "Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer", Dig Endosc, 28, pp.3~15 (2016)
- Ono H, "Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer(second edition)", Dig Endosc, 33, pp.4~20 (2021)
- Pimentel-Nunes P, "Endoscopic submucosal dissection : European Society of Gastrointestinal Endoscopy(ESGE)Guideline", Endoscopy, 47, pp.829~854 (2015)
- Shichijo S, "Long-term outcomes after endoscopic submucosal dissection for differentiatedtype early gastric cancer that fulfilled expanded indication criteria : a prospective cohort study", J Gastroenterol Hepatol, 36, pp.664~670 (2021)
- Kwack WG, "Understanding the diagnostic yield of current endoscopic biopsy for gastric neoplasm:a prospective single-center analysis based on tumor characteristics stratified by biopsy number and site", Medicine(Baltimore), 95, pp.e4196~ (2016)
- Lal N, "Optimal number of biopsy specimens in the diagnosis of carcinoma of the oesophagus", Gut, 33, pp.724~726 (1992)
- 최여원, "Optimal Number of Endoscopic Biopsies in Diagnosis of Advanced Gastric and Colorectal Cancer", Journal of Korean Medical Science, 27(1), pp.36~39 (2012), 대한의학회
- Graham DY, "Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma", Gastroenterology, 82, pp.228~231 (1982)
- Dekker W, "Diagnostic accuracy of fiberendoscopy in the detection of upper intestinal malignancy : a followup analysis", Gastroenterology, 73(4 Pt 1), pp.710~714 (1977)
- Kim YJ, "Histologic diagnosis based on forceps biopsy is not adequate for determining endoscopic treatment of gastric adenomatous lesions", Endoscopy, 42, pp.620~626 (2010)
- Xu G, "Risk factors for under-diagnosis of gastric intraepithelial neoplasia and early gastric carcinoma in endoscopic forceps biopsy in comparison with endoscopic submucosal dissection in Chinese patients", Surg Endosc, 30, pp.2716~2722 (2016)
- Soh JS, "Does the discrepancy in histologic differentiation between a forceps biopsy and an endoscopic specimen necessitate additional surgery in early gastric cancer?", World J Gastrointest Oncol, 9, pp.319~326 (2017)
- Japanese Gastric Cancer Association, "Japanese gastric cancer treatment guidelines 2018(5th edition)", Gastric Cancer, 24, pp.1~21 (2021)
- Japanese Gastric Cancer Association, "Japanese gastric cancer treatment guidelines 2014(ver. 4)", Gastric Cancer, 20, pp.1~19 (2017)
- Beijing Society of Digestive Endodcopology, "Expert consensus on standard diagnosis and treatment of low grade intraepithelial neoplasm", Chin J Gastrointest Endosc, 6, pp.49~56 (2019)
- National Clinical Research Center for Digestive Disease, "Chinese consensus on management of gastric epithelial precancerous conditions and lesions(2020)", Chin J Dig, 40, pp.731~741 (2020)
- Yamada Y, "Docetaxel plus cisplatin and S-1 versus cisplatin and S-1 in patients with advanced gastric cancer(JCOG1013) : an open-label, phase 3, randomised controlled trial", Lancet Gastroenterol Hepatol, 4, pp.501~510 (2019)
- Choi CW, "The risk factors for discrepancy after endoscopic submucosal dissection of gastric category 3 lesion(low grade dysplasia)", Dig Dis Sci, 59, pp.421~427 (2014)
- Yabuuchi Y, "Discrepancy between endoscopic and pathological ulcerative findings in clinical intramucosal early gastric cancer", Gastric Cancer, 24, pp.691~700 (2021)
- Maekawa A, "Incidence of gastric adenocarcinoma among lesions diagnosed as low-grade adenoma", dysplasia on endoscopic biopsy : a multicenter, prospective, observational study, 2018, pp.30, 228~235
- Nam HS, "Endoscopic predictive factors associated with local recurrence after gastric endoscopic submucosal dissection", Scand J Gastroenterol, 53, pp.1000~1007 (2018)
- Balachandran VP, "Nomograms in oncology : more than meets the eye", Lancet Oncol, 16, pp.e173~e180 (2015)
- Hwang JW, "Predicting pre-and postresectional histologic discrepancies in gastric low-grade dysplasia : a comparison of white-light and magnifying endoscopy", J Gastroenterol Hepatol, 31, pp.394~402 (2016)
- Cho SJ, "Risk of high-grade dysplasia or carcinoma in gastric biopsy-proven low-grade dysplasia : an analysis using the Vienna classification", Endoscopy, 43, pp.465~471 (2011)
- Kang DH, "Predictors of upstage diagnosis after endoscopic resection of gastric low-grade dysplasia", Surg Endosc, 32, pp.2732~2738 (2018)
- 전정원, "Clinical Outcomes of Endoscopic Resection for Low-Grade Dysplasia and High-Grade Dysplasia on Gastric Pretreatment Biopsy: Korea ESD Study Group", Gut and Liver, 15(2), pp.225~231 (2021), 거트앤리버 소화기연관학회협의회[DOI]
- 김준미, "Inter-observer Reproducibility in the Pathologic Diagnosis of Gastric Intraepithelial Neoplasia and Early Carcinoma in Endoscopic Submucosal Dissection Specimens: A Multi-center Study", Cancer Research and Treatment, 51(4), pp.1568~1577 (2019), 대한암학회
- de Vries AC, "Gastric cancer risk in patients with premalignant gastric lesions : a nationwide cohort study in the Netherlands", Gastroenterology, 134, pp.945~952 (2008)
- Kato M, "Endoscopic submucosal dissection as a treatment for gastric noninvasive neoplasia : a multicenter study by Osaka University ESD Study Group", J Gastroenterol, 46, pp.325~331 (2011)
- Kang HJ, "Lymph node metastasis from intestinal-type early gastric cancer : experience in a single institution and reassessment of the extended criteria for endoscopic submucosal dissection", Gastrointest Endosc, 72, pp.508~515 (2010)
- Kim Y, "Effect of histologic differences between biopsy and final resection on treatment outcomes in early gastric cancer", Surg Endosc, 34, pp.5046~5054 (2020)
- Ryu DG, "Clinical outcomes of endoscopic submucosa dissection for high-grade dysplasia from endoscopic forceps biopsy", Gastric Cancer, 20, pp.671~678 (2017)
- Takao M, "Discrepancies in histologic diagnoses of early gastric cancer between biopsy and endoscopic mucosal resection specimens", Gastric Cancer, 15, pp.91~96 (2012)
- Yang C, "Causal relevance of circulating high-density lipoprotein cholesterol with cancer : a Mendelian randomization meta-analysis", Sci Rep, 5, pp.9495~ (2015)
- Nam SY, "Effect of Helicobacter pylori eradication and high-density lipoprotein on the risk of de novo gastric cancer development", Gastrointest Endosc, 90, pp.448~456 (2019)
- Kim EH, "Impact of metabolic syndrome on oncologic outcome after radical gastrectomy for gastric cancer", Clin Res Hepatol Gastroenterol, 38, pp.372~378 (2014)
- Li F, "The association between metabolic syndrome and gastric cancer in Chinese", Front Oncol, 8, pp.326~ (2018)
- Gerig R, "Gastric Helicobacter pylori infection is associated with adverse metabolic traits in severely obese subjects", Obesity(Silver Spring), 21, pp.535~537 (2013)
- Castro JP, "The two faces of reactive oxygen species(ROS)in adipocyte function and dysfunction", Biol Chem, 397, pp.709~724 (2016)
- Braun S, "The link between the metabolic syndrome and cancer", Int J Biol Sci, 7, pp.1003~1015 (2011)
- Correa P, "Human gastric carcinogenesis : a multistep and multifactorial process : First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention", Cancer Res, 52, pp.6735~6740 (1992)
- Wang FH, "The Chinese Society of Clinical Oncology (CSCO): clinical guidelines for the diagnosis and treatment of gastric cancer", Cancer Commun(Lond), 39, pp.10~ (2019)
- Watari J, "Helicobacter pylori associated chronic gastritis, clinical syndromes, precancerous lesions, and pathogenesis of gastric cancer development", World J Gastroenterol, 20, pp.5461~5473 (2014)
- Crisan A, "Clinical, histological and prognosis correlations in diagnosis and treatment of gastric cancer", Curr Health Sci J, 42, pp.238~256 (2016)
- Gallo A, "Updates on esophageal and gastric cancers", World J Gastroenterol, 12, pp.3237~3242 (2006)
- National Institute for Health and Care Excellence(NICE), "Suspected cancer: recognition and referral", NICE, ~ (2015)
- Spahos T, "Endoscopy waiting times and impact of the two week wait scheme on diagnosis and outcome of upper gastrointestinal cancer", Postgrad Med J, 81, pp.728~730 (2005)
- Banks M, "British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma", Gut, 68, pp.1545~1575 (2019)
- Machlowska J, "Gastric cancer : epidemiology, risk factors, classification, genomic characteristics and treatment strategies", Int J Mol Sci, 21, pp.4012~ (2020)
- Kim GH, "Screening and surveillance for gastric cancer in the United States : is it needed?", Gastrointest Endosc, 84, pp.18~28 (2016)
- Pimentel-Nunes P, "Management of epithelial precancerous conditions and lesions in the stomach(MAPS II) : European Society of Gastrointestinal Endoscopy(ESGE), European Helicobacter and Microbiota Study Group(EHMSG), European Society of Pathology(ESP), and Sociedade Portuguesa de Endoscopia Digestiva(SPED)guideline update 2019", Endoscopy, 51, pp.365~388 (2019)
- Kitagawa Y, "Magnified endoscopic observation of small depressed gastric lesions using linked color imaging with indigo carmine dye", Endoscopy, 50, pp.142~147 (2018)
- Buxbaum JL, "Narrowband imaging versus white light versus mapping biopsy for gastric intestinal metaplasia : a prospective blinded trial", Gastrointest Endosc, 86, pp.857~865 (2017)
- Pimentel-Nunes P, "A multicenter prospective study of the real-time use of narrow-band imaging in the diagnosis of premalignant gastric conditions and lesions", Endoscopy, 48, pp.723~730 (2016)