Abstract
Submucosal deep invasion of gastric cancer (T1b2; depth of submucosal invasion ≥ 500 μm) is a risk factor for lymph node metastasis and, thus, is one of the criteria for curative treatment. Our aim was to evaluate the specific influence of endoscopic submucosal dissection (ESD) on the prognosis of patients with T1b2 gastric cancer. This was a retrospective analysis of 248 consecutive patients, with 252 pT1b2 gastric cancer lesions, who underwent ESD prior to additional surgery (Group A, n = 101) or surgery only (Group B, n = 147). After propensity score-matching (for sex, age, tumor diameter and gross type), we compared pathological characteristics between the 2 groups and the prognosis over a follow-up period ≥ 60 months. Compared to Group B, patients in Group A were older, with a higher proportion of men. The proportion of depressed and undifferentiated type tumors was greater in Group B than A, with larger tumor size and depth of submucosal invasion as well. There was no incidence of local recurrence, but distant metastasis was identified in 5% of cases in Group A and 3% in Group B. After propensity score-matching, there were no difference in the 5-year overall survival rate between Group A and B (87.5% vs. 91.2%, respectively), nor in the 5-year disease-specific survival rate (96.3% vs. 96.4%, respectively). ESD prior to surgery for T1b2 gastric cancer did not adversely affect clinical outcomes after additional surgery.
Highlights
Submucosal deep invasion of gastric cancer (T1b2; depth of submucosal invasion ≥ 500 μm) is a risk factor for lymph node metastasis and, is one of the criteria for curative treatment
Group A had a higher proportion of men than Group B (79% (80/101) vs. 63% (93/147), p < 0.01), and patients were older in Group A than B (69.4 ± 10.1 years vs. 67.0 ± 11.5 years, respectively; p < 0.05)
lymph node (LN) metastasis was identified in 16 patients (16%) in Group A and 25 (16%) in Group B (p = 0.81)
Summary
Submucosal deep invasion of gastric cancer (T1b2; depth of submucosal invasion ≥ 500 μm) is a risk factor for lymph node metastasis and, is one of the criteria for curative treatment. Our aim was to evaluate the specific influence of endoscopic submucosal dissection (ESD) on the prognosis of patients with T1b2 gastric cancer. This was a retrospective analysis of 248 consecutive patients, with 252 pT1b2 gastric cancer lesions, who underwent ESD prior to additional surgery (Group A, n = 101) or surgery only (Group B, n = 147). Abbreviations ESD Endoscopic submucosal dissection EGC Early gastric cancer JGC Japanese Gastric Cancer Association SM Submucosal LN Lymph node OS Overall survival DSS Disease-specific survival ROC curve Receiver operating characteristic curve. For gastric cancers with deep submucosal (SM) invasion (T1b2; depth of submucosal invasion ≥ 500 μm) identified in the pathological evaluation after ESD, due to the risk of lymph node (LN) metastasis
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