Abstract
BackgroundMetachronous gastric tumor (MGT) is one of major concerns after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Optimal follow-up strategy has not been yet well-established. The aim of this study was to identify the different clinical features of the patients according to the time interval to development of MGT.MethodsAmong 1,780 consecutive patients with EGC who underwent ESD between 2005 and 2014, 115 patients with MGT were retrospectively reviewed. MGT was defined as secondary gastric cancer or dysplasia detected > 1 year after initial ESD. Clinicopathological factors associated with early development of MGT were evaluated.ResultsThe median interval to development of MGT was 37 months. In univariate analysis, the median interval to MGT was shorter if EGC lesion was non-elevated type (39.4 vs 57.0 months, p = 0.011), or synchronous primary lesion was absent (39.8 vs 51.4 months, p = 0.050). In multivariate Cox’s proportional hazards analysis, the hazard ratios for early occurrence of MGT were 1.966 (95% CI: 1.141–3.386, p = 0.015) and 1.911 (95% CI: 1.163–3.141, p = 0.011), respectively. There was no significant difference in overall survival after diagnosis of MGT between the early occurrence group and the late occurrence group.ConclusionsNon-elevated gross type and absence of synchronous gastric tumor were independent risk factors for early development of MGT. Meticulous endoscopic inspection is especially important for the detection of MGT during the early follow-up period in patients with these initial tumor characteristics.
Highlights
Gastric cancer is the fifth most common cancer in the world, half of which occurs in eastern Asia
The median interval to Metachronous gastric tumor (MGT) was shorter if early gastric cancer (EGC) lesion was non-elevated type (39.4 vs 57.0 months, p = 0.011), or synchronous primary lesion was absent (39.8 vs 51.4 months, p = 0.050)
In multivariate Cox’s proportional hazards analysis, the hazard ratios for early occurrence of MGT were 1.966 and 1.911, respectively
Summary
Gastric cancer is the fifth most common cancer in the world, half of which occurs in eastern Asia. In Korea, more than half of newly detected gastric cancers are in their early stages due to the biennial upper endoscopic examination included in the National Cancer Screening Program [3,4,5]. Prognosis of early gastric cancer (EGC) is generally excellent after surgical resection, with a 5-year overall survival rate (OS) over 90 percent [6, 7]. Data from previous studies show that clinical outcomes such as 5-year OS and recurrence rate after endoscopic submucosal dissection (ESD) are comparable to those after gastrectomy in patients with EGC [8,9,10]. Metachronous gastric tumor (MGT) is one of major concerns after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC).
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
