Clinical outcomes of endoscopic resection for undifferentiated intramucosal early gastric cancer larger than 2 cm
- Yang, Hyo-Joon; Nam, Su Youn; Min, Byung-Hoon; Ahn, Ji Yong; Jang, Jae-Young; Kim, Jung; Kim, Jie-Hyun; Lee, Wan-Sik; Lee, Bong Eun; Joo, Moon Kyung; Park, Jae Myung; Shin, Woon Geon; Lee, Hang Lak; Gweon, Tae-Geun; Park, Moo In; Choi, Jeongmin; Tae, Chung Hyun; Kim, Young-Il; Choi, Il Ju
- Issue Date
- Springer Verlag
- Stomach neoplasms; Undifferentiated-type histology; Endoscopic mucosal resection; Treatment outcome; Lymph node metastasis
- Gastric Cancer, v.24, no.2, pp.435 - 444
- Journal Title
- Gastric Cancer
- Start Page
- End Page
This study investigated the long-term clinical outcomes of endoscopic resection (ER) for undifferentiated-type (UD) early gastric cancer (EGC), with tumor size > 2 cm as the only non-curative factor.
From among 1123 patients who underwent ER for UD EGC at 18 tertiary hospitals in Korea between 2005 and 2014, we identified 216 patients with UD intramucosal EGC > 2 cm, which was completely resected, with negative resection margins, and absence of ulceration and lymphovascular invasion. The patients were divided into the additional surgery (n = 40) or observation (n = 176) groups, according to post-ER management and were followed up for a median duration of 59 months for recurrence and 90 months for overall survival.
Lymph node (LN) or distant metastasis or cancer-related mortality was not observed in the surgery group. In the observation group, two (1.1%) patients developed LN or distant metastasis with a 5-year cumulative risk of 0.7%, and one (0.6%) patient died of gastric cancer. The 5- and 8-year overall survival rates were 94.1% and 89.9%, respectively, in the observation group and 100.0% and 95.2%, respectively, in the surgery group (log-rank P = 0.159). Cox regression analysis did not reveal an association between the observation group and increased mortality.
The risk of LN or distant metastasis was not negligible, but as low as 1% for patients undergoing non-curative ER for UD EGC, with tumor size > 2 cm as the only non-curative factor. Close observation may be an alternative to surgery, especially for older patients or those with poor physical status.
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- 2. Clinical Science > Department of Gastroenterology and Hepatology > 1. Journal Articles
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