The superficial elevated and depressed lesion type is an independent factor associated with non-curative endoscopic submucosal dissection for early gastric cancer
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The expanded criteria for endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) have led to an increase in the number of EGC patients who receive curative treatment involving endoscopic techniques. Identifying the factors that are associated with treatment outcomes would be helpful in the application of ESD for EGC.
Potential factors associated with incomplete ESD and with non-curative ESD were investigated using a multiple logistic regression model in EGC patients who consecutively underwent ESD according to the expanded criteria.
A total of 363 patients with 398 EGC lesions were enrolled. The rates of complete ESD and curative ESD were 96.2 % (383/398) and 85.7 % (341/398), respectively. No significant factors associated with incomplete ESD were identified. In contrast, a tumor size >20 mm [odds ratio (OR) 3.31; 95 % confidence interval (CI) 1.74–6.29], the superficial elevated and depressed type (0-IIa + IIc or IIc + IIa) (OR 4.37; 95 % CI 1.88–9.88), and the undifferentiated type (OR 5.93; 95 % CI 1.65–19.41) were identified as independent factors associated with non-curative ESD. The superficial elevated and depressed type in particular was found to be highly related to submucosal and lymphovascular invasion. The rate of non-curative ESD in cases of this macroscopic type occurring together with a tumor size >20 mm was 58.3 %, and the adjusted OR was 16.48 (95 % CI 4.69–62.09).
The results suggest that the superficial elevated and depressed type is an independent factor associated with non-curative ESD and that the risk of non-curative ESD is increased when this macroscopic type is present along with a large tumor size.
KeywordsEarly gastric cancer Endoscopic submucosal dissection Macroscopic type
The authors thank Dr. Kaori Sugiura, Department of Gastroenterology, Kurashiki Central Hospital, for reviewing the data from the enrolled patients.
Compliance with ethical standards
Drs. Yoshiko Ohara, Nobuyuki Toshikuni, Kazuhiro Matsueda, Hirokazu Mouri, and Hiroshi Yamamoto have no conflicts of interest or financial ties to disclose.
- 22.Toyokawa T, Inaba T, Omote S, Okamoto A, Miyasaka R, Watanabe K, Izumikawa K, Fujita I, Horii J, Ishikawa S, Morikawa T, Murakami T, Tomoda J (2015) Risk factors for non-curative resection of early gastric neoplasms with endoscopic submucosal dissection: analysis of 1,123 lesions. Exp Ther Med 9:1209–1214PubMedPubMedCentralGoogle Scholar
- 24.Yamada T, Sugiyama H, Ochi D, Akutsu D, Suzuki H, Narasaka T, Moriwaki T, Endo S, Kaneko T, Satomi K, Ikezawa K, Mizokami Y, Hyodo I (2014) Risk factors for submucosal and lymphovascular invasion in gastric cancer looking indicative for endoscopic submucosal dissection. Gastric Cancer 17:692–696CrossRefPubMedGoogle Scholar
- 31.Kim GH, do Park Y, Kida M, Kim DH, Jeon TY, Kang HJ, Kim DU, Choi CW, Lee BE, Heo J, Song GA (2010) Accuracy of high-frequency catheter-based endoscopic ultrasonography according to the indications for endoscopic treatment of early gastric cancer. J Gastroenterol Hepatol 25:506–511CrossRefPubMedGoogle Scholar
- 32.Okada K, Fujisaki J, Kasuga A, Omae M, Yoshimoto K, Hirasawa T, Ishiyama A, Yamamoto Y, Tsuchida T, Hoshino E, Igarashi M, Takahashi H (2011) Endoscopic ultrasonography is valuable for identifying early gastric cancers meeting expanded-indication criteria for endoscopic submucosal dissection. Surg Endosc 25:841–848CrossRefPubMedGoogle Scholar