Long-term outcome of endoscopic submucosal dissection for early gastric cancer in patients with severe comorbidities: a comparative propensity score analysis
- 332 Downloads
Recently, endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) has been performed on patients with severe comorbidities because it is less invasive, although little is known regarding long-term outcomes. This study aimed to assess the long-term outcomes of ESD for patients with severe and non-severe comorbidities.
We enrolled 1081 patients who underwent ESD for EGC between February 2004 and June 2013. Based on the American Society of Anesthesiologists Physical Status (ASA-PS) classification, we defined patients with severe and non-severe comorbidities as ASA-PS 3 and 1/2, respectively. We retrospectively compared the overall survival, risk factors for mortality, and adverse events between these two groups using propensity score matching and inverse probability of treatment weighting.
A total of 488 patients met the eligibility criteria. After matching, the ASA-PS 3 group showed a significantly shorter survival than the ASA-PS 1/2 group (5-year overall survival rate, 79.1 vs. 87.7%; p < 0.01). In addition, only the ASA-PS 3 group had a significant risk factor for mortality using both the Cox analysis [hazard ratio (HR), 2.56; 95% confidence interval (CI) 1.18–5.52; p = 0.02] and the IPTW method (HR, 3.14; 95% CI 1.91–5.14; p < 0.01). There was no significant difference in adverse events after matching between the two groups (p = 0.21).
The long-term outcome of gastric ESD for patients with severe comorbidities was worse than for those with non-severe comorbidities. Further studies will be necessary to determine if ESD is truly warranted in these patients.
KeywordsEndoscopic submucosal dissection Early gastric cancer Long-term outcome American Society of Anesthesiologists Physical Status Propensity score analysis
No funders and grants.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Human rights statement
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.
Informed consent or a substitute for such consent was obtained from all patients before inclusion in our study.
- 9.Yoshioka T, Nishida T, Tsujii M, Kato M, Hayashi Y, Komori M, et al. Renal dysfunction is an independent risk factor for bleeding after gastric ESD. Endosc Int Open. 2015;3::E39–45.Google Scholar
- 15.American Society of Anesthesiologists. ASA physical status classification system [Internet]. https://www.asahq.org/resources/clinical-information/asa-physical-status-classification-system. Accessed 24 Sep 2018.
- 20.Nagami Y, Tominaga K, Machida H, Nakatani M, Kameda N, Sugimori S, et al. Usefulness of non-magnifying narrow-band imaging in screening of early esophageal squamous cell carcinoma: a prospective comparative study using propensity score matching. Am J Gastroenterol. 2014;109::845–54.CrossRefGoogle Scholar
- 22.Fukunaga S, Nagami Y, Shiba M, Ominami M, Tanigawa T, Yamagami H, et al. Long-term prognosis of expanded-indication differentiated-type early gastric cancer treated with endoscopic submucosal dissection or surgery using propensity score analysis. Gastrointest Endosc. 2017;85:143–52.CrossRefGoogle Scholar