Abstract
BackgroundEndoscopic submucosal dissection (ESD) is gaining enormous popularity in the treatment of early gastric cancers (EGCs) in many institutions across the world. However, appropriate selection of candidates for endoscopic resection is crucial to sufficiently mitigate non-e-curative (NEC) resection. This study aims at identifying the various clinico-pathologic factors that independently predict the NEC outcome and depth of submucosal invasion following ESD procedure in patients with EGC.MethodsMultiple logistic regression analysis was applied to investigate factors that independently predict both non-curability phenomenon and the level of submucosal invasion in patients with early gastric neoplasia. Statistical Packages for the Social Sciences version 23 was used for analysis.ResultsA total of 153 patients (162 EGC lesions) underwent en-bloc ESD after which the rate of complete resection and non-e-curative outcome were 95% and 22.2%, correspondingly. Multivariate analysis depicted that tumor location in the upper two third of stomach (odds ratio [OR], 5.46; 95% confidence interval [95% CI], 1.65–18.12; p = 0.006), tumor size > 2 cm (OR, 7.63; 95% CI, 2.29–25.42; p = 0.001), histologically undifferentiated tumor (OR, 15.54; 95% CI, 1.65–146.22; p = 0.001), and tumors with 0-IIa/0-IIc or their mixed variants with predominant 0-IIa/0-IIc (OR, 9.77; 95% CI, 1.23–77.65; p = 0.031) were all independent predictors of NEC resection for early gastric tumors. Additionally, location in the upper two third of the stomach (OR, 8.88; 95% CI, 2.90–27.17; p < 0.001), ulcerated lesions (OR, 3.70; 95% CI, 1.15–11.90; p = 0.028), lesions with > 2 cm (OR, 2.94; 95% CI, 1.08–8.02; p = 0.036) and those with poor differentiation (OR, 6.51; 95% CI, 2.23–18.98; p = 0.001) were found to have significant association with submucosal invasion.ConclusionsTumors located in the upper two third of the stomach having a larger size (> 2 cm), poor histo-differentiation and a gross type of 0-IIa/0-IIc or their mixed variants with predominant 0-IIa/0-IIc were significantly associated with a risk of NEC after ESD procedure. Thus, early gastric tumors displaying these features need to be handled carefully during endoscopic resection. Our findings may shed light on the pre-procedural detection of clinicopathologic factors that determine non-e-curability in patients with EGC.
Highlights
Endoscopic submucosal dissection (ESD) is gaining enormous popularity in the treatment of early gastric cancers (EGCs) in many institutions across the world
According to Japanese Gastric Cancer Association (JGCA) [3] classification scheme, EGCs belong to class zero (‘0’), which are further subdivided into specific subtypes
Our study demonstrated that EGCs with undifferentiated histology are significantly associated with NEC outcome in a multivariate analysis
Summary
Endoscopic submucosal dissection (ESD) is gaining enormous popularity in the treatment of early gastric cancers (EGCs) in many institutions across the world. This study aims at identifying the various clinico-pathologic factors that independently predict the NEC outcome and depth of submucosal invasion following ESD procedure in patients with EGC. According to Japanese Gastric Cancer Association (JGCA) [3] classification scheme, EGCs belong to class zero (‘0’), which are further subdivided into specific subtypes. These class ‘0’ lesions include protruding type (0-I), superficial lesions with elevation (0-IIa), superficial flat (0-IIb), superficial depressed (0-IIc) and the last type encompasses excavated lesions (0-III). The occurrence of combined macroscopic features is not uncommon, where the more dominant type is written first followed by the other [4]
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