Long-Term Clinical Outcomes of Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Prospective Multicenter Cohort Study
2
조회
0
다운로드
20
인용
0
참고문헌
키워드
초록
Background/Aims: Endoscopic submucosal dissection (ESD) has been regarded as a curative treatment for early gastric cancer (EGC) in indicated cases. The aim of this study was to evaluate the nationwide long-term clinical outcomes of ESD for EGC in Korea. Methods: A prospective multicenter cohort study was performed to evaluate the long-term efficacy of ESD for EGC within pre-defined indications at 12 institutes in Korea. The cases that met the expanded criteria upon pathological review after ESD were followed for 5 years. The primary outcome was 5-year disease specific free survival. Results: Six hundred ninety-seven patients with 722 EGCs treated with ESD were prospectively enrolled and followed for 5 years. Complete resection was achieved in 81.3% of the cases, and curative resection was achieved in 86.1%. During the 5-year follow-up, the overall survival rate was 96.6%, and the disease specific free survival rate was 90.6%. Local recurrence developed in 0.9%, and metachronous tumor development occurred in 7.8%; both conditions were treated by endoscopic or surgical treatment. Distant metastasis developed in 0.5% during follow-up. Conclusions: ESD showed excellent long-term clinical outcomes and can be accepted as a curative treatment for patients with EGC who meet the expanded criteria in final pathology studies.
Abstract
Background/Aims: Endoscopic submucosal dissection (ESD) has been regarded as a curative treatment for early gastric cancer (EGC) in indicated cases. The aim of this study was to evaluate the nationwide long-term clinical outcomes of ESD for EGC in Korea. Methods: A prospective multicenter cohort study was performed to evaluate the long-term efficacy of ESD for EGC within pre-defined indications at 12 institutes in Korea. The cases that met the expanded criteria upon pathological review after ESD were followed for 5 years. The primary outcome was 5-year disease specific free survival. Results: Six hundred ninety-seven patients with 722 EGCs treated with ESD were prospectively enrolled and followed for 5 years. Complete resection was achieved in 81.3% of the cases, and curative resection was achieved in 86.1%. During the 5-year follow-up, the overall survival rate was 96.6%, and the disease specific free survival rate was 90.6%. Local recurrence developed in 0.9%, and metachronous tumor development occurred in 7.8%; both conditions were treated by endoscopic or surgical treatment. Distant metastasis developed in 0.5% during follow-up. Conclusions: ESD showed excellent long-term clinical outcomes and can be accepted as a curative treatment for patients with EGC who meet the expanded criteria in final pathology studies.
참고문헌 (14)
- Karimi P, "Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention", Cancer Epidemiol Biomarkers Prev, 23, pp.700~713 (2014)[DOI]
- 정규원, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2014", Cancer Research and Treatment, 49(2), pp.292~305 (2017), 대한암학회
- 서민아, "Trends in Cancer Screening Rates among Korean Men and Women: Results from the Korean National Cancer Screening Survey, 2004-2012", Cancer Research and Treatment, 45(2), pp.86~94 (2013), 대한암학회
- 김윤경, "Effects of Screening on Gastric Cancer Management: Comparative Analysis of the Results in 2006 and in 2011", Journal of Gastric Cancer, 14(2), pp.129~134 (2014), 대한위암학회[DOI]
- 김상균, "Quality of Life after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Prospective Multicenter Cohort Study", Gut and Liver, 11(1), pp.87~92 (2017), 거트앤리버 소화기연관학회협의회
- Il Ju Choi, "Short-Term Outcomes of Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Prospective Multicenter Cohort Study", Gut and Liver, 10(5), pp.739~748 (2016), 거트앤리버 소화기연관학회협의회
- Choi J, "Long-term clinical outcomes of endoscopic resection for early gastric cancer", Surg Endosc, 29, pp.1223~1230 (2015)[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]
- Choi IJ, "Long-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection", Gastrointest Endosc, 81, pp.333~341 (2015)[DOI]
- Schlemper RJ, "The Vienna classification of gastrointestinal epithelial neoplasia", Gut, 47, pp.251~255 (2000)[DOI]
- Yoon H, "Risk factors of residual or recurrent tumor in patients with a tumor-positive resection margin after endoscopic resection of early gastric cancer", Surg Endosc, 27, pp.1561~1568 (2013)[DOI]
- Japanese Gastric Cancer Association, "Japanese gastric cancer treatment guidelines 2010 (ver. 3)", Gastric Cancer, 14, pp.113~123 (2011)[DOI]
- 김윤희, "Cost Comparison between Surgical Treatments and Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer in Korea", Gut and Liver, 9(2), pp.174~180 (2015), 거트앤리버 소화기연관학회협의회
- Park SR, "Prognostic value of preoperative clinical staging assessed by computed tomography in resectable gastric cancer patients: a viewpoint in the era of preoperative treatment", Ann Surg, 251, pp.428~435 (2010)[DOI]