Abstract
Background and Study Aim: EGC, also known as Early Gastric Cancer is known to lack the lymph node metastasis and confined along the mucosa, which is treated through an endoscopic resection procedure that includes ESD (Endoscopic Submucosal dissection) and EMR (Endoscopic Mucosal Resection). However, some cases underwent residual disease, recurrence, or additional gastrectomy because of non-curative resection. The following research aims to delineate the threat factors causing the non-curative resection as well as develop a predictive model.Patient and Methods: Effort was taken to collect all the records about the health history of pathologically diagnosed EGC who experienced endoscopic treatment in the Department of Endoscopy, the Capital Medical University, and Beijing Friendship Hospital from January 2012 to January 2020. Patients were grouped into two categories primarily; a curative resection group and finally a non-curative resection group based on the outcomes of the postoperative pathological and immunohistochemical examination results. The statistical methods used included single factor analysis, a multivariate logistic regression analysis and a chi-square test. A nomogram for the prediction of non-curative resection was constructed, which included information on age, gender, resection method, postoperative pathology, tumor size, ulcer, treatment, and infiltration depth. Receiver operating characteristic (ROC) curve analysis and calibration were performed to present the predictive accuracy of the nomogram.Results: Of 443 patients with 478 lesions who had undergone ESD or EMR for EGCs, 127 were identified as being treated non-curative resection. Older patients (>60 years), a large tumor size (>30 mm), submucosal lesion, piecemeal resection, EMR for treatment and undifferentiated tumor histology were associated with non-curative resection group. Our risk nomogram showed good discriminated performance in internal validation (bootstrap-corrected area under the receiver-operating characteristic curve, 0.881; P < 0.001).Conclusions: A validated prediction model was developed to identify people who were subject to undergoing a non-curative resection for ESD. The predictive model that we formulated is essential in providing reliable information to guide the decision-making process on the treatment for EGC before undertaking an endoscopic resection.
Highlights
early gastric cancer (EGC), commonly known as Early Gastric Cancer, is the kind of tumorous tissue that affects the gastric submucosa or mucosa in the presence and or absenteeism of lymph node metastasis
We constructively examined clinical data for patients that had undergone endoscopic resection from the Department of Endoscopy, the Capital Medical University affiliated Beijing Friendship Hospital from January 2012 to January 2020
Four hundred forty-three patients with four hundred seventyeight lesions were suffering from EGC
Summary
EGC, commonly known as Early Gastric Cancer, is the kind of tumorous tissue that affects the gastric submucosa or mucosa in the presence and or absenteeism of lymph node metastasis. Extensive multicenter studies have shown that relative to surgical gastrectomy, the procedures for endoscopic resection entails numerous advantages of less trauma, fewer complications, and high quality of life and it is widely accepted, in high incidence in Asian countries [3]. It has become the first choice for patients with high-grade intraepithelial neoplasia and EGC [4, 5]. A nomogram for the prediction of non-curative resection was constructed, which included information on age, gender, resection method, postoperative pathology, tumor size, ulcer, treatment, and infiltration depth. Receiver operating characteristic (ROC) curve analysis and calibration were performed to present the predictive accuracy of the nomogram
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