Abstract
Background. Recently, endoscopic submucosal dissection (ESD) has become a standard treatment method for early gastric cancer and concurrent stomach preservation. However, metachronous recurrences have become a major problem. We evaluated the incidence and clinicopathologic features of and examined the risk factors for metachronous gastric tumors. Methods. A total of 357 patients who underwent ESD for gastric tumors (245 early gastric cancers and 112 adenomas) and were followed up for more than 12 months without recurrence within the first 12 months were enrolled. We investigated the incidence and clinicopathologic features of metachronous tumors after ESD. We also analyzed the potential risk factors for metachronous tumors using the Kaplan-Meier method and Cox's proportional hazards model. Results. The annual incidence of metachronous tumors after ESD was 2.4%. The median period until discovery after initial ESD was 26.0 months, and the median observation period was 52.6 months. Male patients developed metachronous tumors more frequently (P = 0.04), and the hazard ratio of female to male patients was 0.36 (95% confidence interval: 0.11–0.89). Conclusions. Patients with a previous history of gastric tumors have a high risk of subsequent gastric tumor development and male patients should be carefully followed up after ESD for gastric tumor.
Highlights
Gastric cancer is the second most frequent cause of cancer death, and the incidence of gastric cancer among developed countries is the highest in Japan [1]
We evaluated the incidence and clinicopathologic features of metachronous multiple tumors that developed during long-term observation and investigated whether we could predict the occurrence of such tumors on the basis of the patient and tumor features during initial endoscopic submucosal dissection (ESD)
We investigated the incidence of metachronous tumors in 357 patients using the Kaplan-Meier method and retrospectively investigated the clinicopathologic features associated with metachronous tumors, including patient age and gender, tumor size, location, gross type, extension of gastric mucosal atrophy, presence of synchronous multiple tumors, histology, and depth
Summary
Gastric cancer is the second most frequent cause of cancer death, and the incidence of gastric cancer among developed countries is the highest in Japan [1]. Endoscopic submucosal dissection (ESD) for EGC has been widely performed in Japan. With this method, stomach preservation and maintenance of the patients’. Endoscopic submucosal dissection (ESD) has become a standard treatment method for early gastric cancer and concurrent stomach preservation. We evaluated the incidence and clinicopathologic features of and examined the risk factors for metachronous gastric tumors. A total of 357 patients who underwent ESD for gastric tumors (245 early gastric cancers and 112 adenomas) and were followed up for more than 12 months without recurrence within the first 12 months were enrolled. We analyzed the potential risk factors for metachronous tumors using the KaplanMeier method and Cox’s proportional hazards model. Patients with a previous history of gastric tumors have a high risk of subsequent gastric tumor development and male patients should be carefully followed up after ESD for gastric tumor
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