Predictive Factors and Long-Term Outcomes of Early Gastric Carcinomas in Patients with Non-Curative Resection by Endoscopic Submucosal Dissection

Ping Xu; Yun Wang; Yini Dang; Qin Huang; Jianhua Wang; Weifeng Zhang; Yifeng Zhang; Guoxin Zhang

doi:10.2147/CMAR.S263525

Predictive Factors and Long-Term Outcomes of Early Gastric Carcinomas in Patients with Non-Curative Resection by Endoscopic Submucosal Dissection

Cancer Manag Res. 2020 Sep 4:12:8037-8046. doi: 10.2147/CMAR.S263525. eCollection 2020.

Authors

Ping Xu^#^{1

2}, Yun Wang^#¹, Yini Dang^#¹, Qin Huang³, Jianhua Wang², Weifeng Zhang¹, Yifeng Zhang⁴, Guoxin Zhang¹

Affiliations

¹ Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.
² Department of Gastroenterology, Yancheng City No.1 People's Hospital, Yancheng, Jiangsu, People's Republic of China.
³ Department of Pathology and Laboratory Medicine, VA Boston Healthcare System and Harvard Medical School, Boston, MA, USA.
⁴ Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: Non-curative resection (NCR) remains problematic in some cases of early gastric carcinomas (EGCs) treated by endoscopic submucosal dissection (ESD). The aim of this study was to identify predictors of NCR, especially of eCura C1 and eCura C2 resections, before ESD and study long-term outcomes of EGC patients with NCR.

Patients and methods: A retrospective review of medical records was conducted over an 8-year period for EGCs undergoing ESD. Clinicopathologic and endoscopic characteristics and patients' survival were analyzed. Risk factors for NCR and eCura C1 and C2 resections were assessed by logistic analyses. Survival of patients was estimated with the Kaplan-Meier method with a Log rank test.

Results: A total of 463 patients with 472 lesions were qualified. By univariate and multivariate analyses, the predictors for NCR and eCura C2 resections were tumor size >20 mm, tumors located in cardia-fundus, uneven surface, margin elevation, and mixed and undifferentiated types, and those for eCura C1 resection were tumors located in cardia-fundus, negative lifting sign, and mixed and undifferentiated types. The 5-year cancer-specific and cancer-free survival rates were 100.0% and 94.2%, and 95.3% and 83.4% in the curative resection (CR) and NCR groups, respectively. The 5-year cancer-specific and cancer-free survival rates were significantly greater in the CR group than that in the NCR group (P <0.0001).

Conclusion: In this cohort, we identified various endoscopic and pathologic features of EGCs to predict NCR, especially eCura C1 and eCura C2 resections before ESD. These clinically valuable factors would be very informative to endoscopists and surgeons who perform ESD to resect EGCs.

Keywords: early gastric carcinoma; endoscopic submucosal dissection; long-term outcome; non-curative resection; stomach.

Grants and funding

The present study was supported by the National Natural Science Foundation of China (no. 81770561) and Jiangsu Province Leading Talents and Innovation Team (CXTDA2017033).