Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer with Undifferentiated-Type Histology: A Clinical Simulation Using a Non- Selected Surgical Cohort
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Background/Aims: Outcomes of endoscopic submucosal dissection (ESD) for undifferentiated-type early gastric cancer (EGC) need to be further evaluated. We aimed to simulate the outcomes of ESD for undifferentiated-type EGC from a surgical database. Methods: Among 802 patients who underwent gastrectomy with endoscopic biopsy for poorly differentiated adenocarcinoma (PD-type) or signet ring cell carcinoma (SRC-type), ESD candidates meeting the expanded indication (n=280) were selected by reviewing the endoscopic images. According to the surgical pathologic results, the outcomes of the ESD simulation were evaluated. Results: Among the candidates, 104 (37.1%) were PD-type and 176 (62.9%) were SRC-type. The curative resection (CR) rate was 42.1%. Among the patients with CR, three patients (2.5%) showed lymph node metastasis (LNM). Three EGCs with CR and LNM were mucosal cancers ≥1.0 cm in size. The CR rate was higher in the SRC-type than in the PD-type (48.3% vs 31.7%, respectively, p=0.007). In the SRC-type, the CR rate was increased, with a smaller size criterion for the ESD indication, but was similar between the 1.0 cm and 0.6 cm criteria (63.3% and 63.6%, respectively), whereas the CR rate was below 50% in all of the different tumor size criteria (2.0 to 0.6 cm) in the PD-type. Conclusions: In undifferentiated- type EGC, ESD should be considered in selected patients with tumor sizes <1 cm and SRC histology.
Abstract
Background/Aims: Outcomes of endoscopic submucosal dissection (ESD) for undifferentiated-type early gastric cancer (EGC) need to be further evaluated. We aimed to simulate the outcomes of ESD for undifferentiated-type EGC from a surgical database. Methods: Among 802 patients who underwent gastrectomy with endoscopic biopsy for poorly differentiated adenocarcinoma (PD-type) or signet ring cell carcinoma (SRC-type), ESD candidates meeting the expanded indication (n=280) were selected by reviewing the endoscopic images. According to the surgical pathologic results, the outcomes of the ESD simulation were evaluated. Results: Among the candidates, 104 (37.1%) were PD-type and 176 (62.9%) were SRC-type. The curative resection (CR) rate was 42.1%. Among the patients with CR, three patients (2.5%) showed lymph node metastasis (LNM). Three EGCs with CR and LNM were mucosal cancers ≥1.0 cm in size. The CR rate was higher in the SRC-type than in the PD-type (48.3% vs 31.7%, respectively, p=0.007). In the SRC-type, the CR rate was increased, with a smaller size criterion for the ESD indication, but was similar between the 1.0 cm and 0.6 cm criteria (63.3% and 63.6%, respectively), whereas the CR rate was below 50% in all of the different tumor size criteria (2.0 to 0.6 cm) in the PD-type. Conclusions: In undifferentiated- type EGC, ESD should be considered in selected patients with tumor sizes <1 cm and SRC histology.
참고문헌 (39)
- Gotoda T, "Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers", Gastric Cancer, 3, pp.219~225 (2000)[DOI]
- Japanese Gastric Cancer Association, "Japanese gastric cancer treatment guidelines 2010 (ver. 3)", Gastric Cancer, 14, pp.113~123 (2011)[DOI]
- 이준행, "Clinical Practice Guidelines for Gastric Cancer in Korea: An Evidence-Based Approach", Journal of Gastric Cancer, 14(2), pp.87~104 (2014), 대한위암학회[DOI]
- Park CH, "Long-term outcome of early gastric cancer after endoscopic submucosal dissection: expanded indication is comparable to absolute indication", Dig Liver Dis, 45, pp.651~656 (2013)[DOI]
- Goto O, "Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria", Endoscopy, 41, pp.118~122 (2009)[DOI]
- Gotoda T, "Endoscopic resection of early gastric cancer treated by guideline and expanded National Cancer Centre criteria", Br J Surg, 97, pp.868~871 (2010)[DOI]
- Lee H, "A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cancer", Surg Endosc, 25, pp.1985~1993 (2011)[DOI]
- Ahn JY, "Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications", Gastrointest Endosc, 74, pp.485~493 (2011)[DOI]
- Choi MK, "Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a singlecenter experience", Surg Endosc, 27, pp.4250~4258 (2013)[DOI]
- Kim YI, "Long-term survival after endoscopic resection versus surgery in early gastric cancers", Endoscopy, 47, pp.293~301 (2015)[DOI]
- Kamada K, "Endoscopic submucosal dissection for undifferentiated early gastric cancer as the expanded indication lesion", Digestion, 85, pp.111~115 (2012)[DOI]
- Kang HY, "Clinical outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer", Surg Endosc, 24, pp.509~516 (2010)[DOI]
- Yamamoto Y, "Therapeutic outcomes of endoscopic submucosal dissection of undifferentiated-type intramucosal gastric cancer without ulceration and preoperatively diagnosed as 20 millimetres or less in diameter", Dig Endosc, 22, pp.112~118 (2010)[DOI]
- Okada K, "Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer", Endoscopy, 44, pp.122~127 (2012)[DOI]
- Abe S, "Short- and long-term outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer", Endoscopy, 45, pp.703~707 (2013)[DOI]
- Min BH, "Endoscopic resection for undifferentiated early gastric cancer: focusing on histologic discrepancies between forceps biopsy-based and endoscopic resection specimenbased diagnosis", Dig Dis Sci, 59, pp.2536~2543 (2014)[DOI]
- Japanese Gastric Cancer Association, "Japanese classification of gastric carcinoma: 3rd English edition", Gastric Cancer, 14, pp.101~112 (2011)[DOI]
- Akahoshi K, "Pretreatment staging of endoscopically early gastric cancer with a 15 MHz ultrasound catheter probe", Gastrointest Endosc, 48, pp.470~476 (1998)[DOI]
- Kim HM, "Early gastric cancer of signet ring cell carcinoma is more amenable to endoscopic treatment than is early gastric cancer of poorly differentiated tubular adenocarcinoma in select tumor conditions", Surg Endosc, 25, pp.3087~3093 (2011)[DOI]
- Ha TK, "Indication for endoscopic mucosal resection in early signet ring cell gastric cancer", Ann Surg Oncol, 15, pp.508~513 (2008)[DOI]
- Park YD, "Factors related to lymph node metastasis and the feasibility of endoscopic mucosal resection for treating poorly differentiated adenocarcinoma of the stomach", Endoscopy, 40, pp.7~10 (2008)[DOI]
- Yamao T, "Risk factors for lymph node metastasis from intramucosal gastric carcinoma", Cancer, 77, pp.602~606 (1996)[DOI]
- Ye BD, "Predictive factors for lymph node metastasis and endoscopic treatment strategies for undifferentiated early gastric cancer", J Gastroenterol Hepatol, 23, pp.46~50 (2008)[DOI]
- Oka S, "Clinical validity of the expanded criteria for endoscopic resection of undifferentiated-type early gastric cancer based on long-term outcomes", Surg Endosc, 28, pp.639~647 (2014)[DOI]
- Kim JH, "Follow-up outcomes of endoscopic resection for early gastric cancer with undifferentiated histology", Surg Endosc, 28, pp.2627~2633 (2014)[DOI]
- Choi J, "Comparison of endoscopic ultrasonography and conventional endoscopy for prediction of depth of tumor invasion in early gastric cancer", Endoscopy, 42, pp.705~713 (2010)[DOI]
- Sawada S, "Expansion of indications for endoscopic treatment of undifferentiated mucosal gastric cancer: analysis of intramucosal spread in resected specimens", Dig Dis Sci, 55, pp.1376~1380 (2010)[DOI]
- Nagahama T, "Usefulness of magnifying endoscopy with narrow-band imaging for determining the horizontal extent of early gastric cancer when there is an unclear margin by chromoendoscopy (with video)", Gastrointest Endosc, 74, pp.1259~1267 (2011)[DOI]
- Ren G, "Prediction of risk factors for lymph node metastasis in early gastric cancer", World J Gastroenterol, 19, pp.3096~3107 (2013)[DOI]
- Boku T, "Strategy for lymphadenectomy of gastric cancer", Surgery, 105, pp.585~592 (1989)
- Seto Y, "Lymph node metastasis and preoperative diagnosis of depth of invasion in early gastric cancer", Gastric Cancer, 4, pp.34~38 (2001)[DOI]
- Lee E, "Prognostic relevance of immunohistochemically detected lymph node micrometastasis in patients with gastric carcinoma", Cancer, 94, pp.2867~2873 (2002)[DOI]
- Choi HJ, "Occurrence and prognostic implications of micrometastases in lymph nodes from patients with submucosal gastric carcinoma", Ann Surg Oncol, 9, pp.13~19 (2002)[DOI]
- Hyung WJ, "Application of minimally invasive treatment for early gastric cancer", J Surg Oncol, 85, pp.181~185 (2004)[DOI]
- Abe N, "Endoscopic treatment or surgery for undifferentiated early gastric cancer?", Am J Surg, 188, pp.181~184 (2004)[DOI]
- Pyo JH, "A risk-prediction model based on lymph-node metastasis for incorporation into a treatment algorithm for signet ring cell-type intramucosal gastric cancer", Ann Surg, 264, pp.1038~1043 (2016)[DOI]
- Pyo JH, "A risk prediction model based on lymph-node metastasis in poorly differentiated-type intramucosal gastric cancer", PLoS One, 11, pp.e0156207~ (2016)[DOI]
- Hirasawa T, "Lymph node metastasis from undifferentiated-type mucosal gastric cancer satisfying the expanded criteria for endoscopic resection based on routine histological examination", Gastric Cancer, 13, pp.267~270 (2010)[DOI]
- Nasu J, "A case of small undifferentiated intramucosal gastric cancer with lymph node metastasis", Gastric Cancer, 13, pp.264~266 (2010)[DOI]