Advertisement

Gastric Cancer

, Volume 22, Issue 3, pp 558–566 | Cite as

Long-term outcome of endoscopic submucosal dissection for early gastric cancer in patients with severe comorbidities: a comparative propensity score analysis

  • Kojiro Tanoue
  • Shusei Fukunaga
  • Yasuaki NagamiEmail author
  • Taishi Sakai
  • Hirotsugu Maruyama
  • Masaki Ominami
  • Koji Otani
  • Shuhei Hosomi
  • Fumio Tanaka
  • Koichi Taira
  • Noriko Kamata
  • Hirokazu Yamagami
  • Tetsuya Tanigawa
  • Masatsugu Shiba
  • Toshio Watanabe
  • Yasuhiro Fujiwara
Original Article
  • 341 Downloads

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Endoscopic submucosal dissection Early gastric cancer Long-term outcome American Society of Anesthesiologists Physical Status Propensity score analysis 

Notes

Funding

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

Informed consent or a substitute for such consent was obtained from all patients before inclusion in our study.

References

  1. 1.
    Isomoto H, Shikuwa S, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut. 2009;58:331–6.CrossRefGoogle Scholar
  2. 2.
    Goto O, Fujishiro M, Kodashima S, Ono S, Omata M. Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. Endoscopy. 2009;41:118–22.CrossRefGoogle Scholar
  3. 3.
    Gotoda T, Iwasaki M, Kusano C, Seewald S, Oda I. Endoscopic resection of early gastric cancer treated by guideline and expanded National Cancer Centre criteria. Br J Surg. 2010;97:868–71.CrossRefGoogle Scholar
  4. 4.
    Ahn JY, Jung HY, Choi KD, Choi JY, Kim MY, Lee JH, et al. Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc. 2011;74:485–93.CrossRefGoogle Scholar
  5. 5.
    Kosaka T, Endo M, Toya Y, Abiko Y, Kudara N, Inomata M, et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center retrospective study. Dig Endosc. 2014;26::183–91.CrossRefGoogle Scholar
  6. 6.
    Oda I, Oyama T, Abe S, Ohnita K, Kosaka T, Hirasawa K, et al. Preliminary results of multicenter questionnaire study on long-term outcomes of curative endoscopic submucosal dissection for early gastric cancer. Dig Endosc. 2014;26:214–19.CrossRefGoogle Scholar
  7. 7.
    Suzuki H, Oda I, Abe S, Sekiguchi M, Mori G, Nonaka S, et al. High rate of 5-year survival among patients with early gastric cancer undergoing curative endoscopic submucosal dissection. Gastric Cancer. 2016;19:198–205.CrossRefGoogle Scholar
  8. 8.
    Kato M, Nishida T, Hamasaki T, Kawai N, Yoshio T, Egawa S, et al. Outcomes of ESD for patients with early gastric cancer and comorbid liver cirrhosis: a propensity score analysis. Surg Endosc. 2015;29:1560–6.CrossRefGoogle Scholar
  9. 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
  10. 10.
    Yoshifuku Y, Oka S, Tanaka S, Sanomura Y, Miwata T, Numata N, et al. Long-term prognosis after endoscopic submucosal dissection for early gastric cancer in super-elderly patients. Surg Endosc. 2016;30:4321–9.CrossRefGoogle Scholar
  11. 11.
    Iwai N, Dohi O, Naito Y, Inada Y, Fukui A, Takayama S, et al. Impact of the Charlson comorbidity index and prognostic nutritional index on prognosis in patients with early gastric cancer after endoscopic submucosal dissection. Dig Endosc. 2018.  https://doi.org/10.1111/den.13051.Google Scholar
  12. 12.
    Saklad M. Grading of patients for surgical procedures. Anesthesiology. 1941;2:281–4.CrossRefGoogle Scholar
  13. 13.
    Hackett NJ, De Oliveira GS, Jain UK, Kim JY. ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg. 2015;18:184–90.CrossRefGoogle Scholar
  14. 14.
    Man-i M, Morita Y, Fujita T, East JE, Tanaka S, Wakahara C, et al. Endoscopic submucosal dissection for gastric neoplasm in patients with co-morbidities categorized according to the ASA Physical Status Classification. Gastric Cancer. 2013;16:56–66.CrossRefGoogle Scholar
  15. 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.
  16. 16.
    Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20:1–19.CrossRefGoogle Scholar
  17. 17.
    Japanese Gastric Cancer A. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.CrossRefGoogle Scholar
  18. 18.
    Rosenbaum PRRD. The bias due to incomplete matching. Biometrics. 1985;41:103–16.CrossRefGoogle Scholar
  19. 19.
    Rubin DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med. 1997;127:757–63.CrossRefGoogle Scholar
  20. 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
  21. 21.
    Suzuki S, Gotoda T, Kusano C, Iwatsuka K, Moriyama M. The efficacy and tolerability of a triple therapy containing a potassium-competitive acid blocker compared with a 7-day PPI-based low-dose clarithromycin triple therapy. Am J Gastroenterol. 2016;111:949–56.CrossRefGoogle Scholar
  22. 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
  23. 23.
    Lunceford JK, Davidian M. Stratification and weighting via the propensity score in estimation of causal treatment effects: a comparative study. Stat Med. 2004;23:2937–60.CrossRefGoogle Scholar
  24. 24.
    Adams TD, Davidson LE, Litwin SE, Kolotkin RL, LaMonte MJ, Pendleton RC, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308:1122–31.CrossRefGoogle Scholar
  25. 25.
    Sano T, Sasako M, Kinoshita T, Maruyama K. Recurrence of early gastric cancer. Follow-up of 1475 patients and review of the Japanese literature. Cancer. 1993;72:3174–8.CrossRefGoogle Scholar
  26. 26.
    Tsukuma H, Oshima A, Narahara H, Morii T. Natural history of early gastric cancer: a non-concurrent, long term, follow up study. Gut. 2000;47:618–21.CrossRefGoogle Scholar
  27. 27.
    Watanabe T, Tanigawa T, Shiba M, Nadatani Y, Nagami Y, Sugimori S, et al. Anti-tumour necrosis factor agents reduce non-steroidal anti-inflammatory drug-induced small bowel injury in rheumatoid arthritis patients. Gut. 2014;63:409–14.CrossRefGoogle Scholar
  28. 28.
    Wang SJ, Lemieux A, Kalpathy-Cramer J, Ord CB, Walker GV, Fuller CD, et al. Nomogram for predicting the benefit of adjuvant chemoradiotherapy for resected gallbladder cancer. J Clin Oncol. 2011;29:4627–32.CrossRefGoogle Scholar

Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Kojiro Tanoue
    • 1
  • Shusei Fukunaga
    • 1
  • Yasuaki Nagami
    • 1
    Email author
  • Taishi Sakai
    • 1
  • Hirotsugu Maruyama
    • 1
  • Masaki Ominami
    • 1
  • Koji Otani
    • 1
  • Shuhei Hosomi
    • 1
  • Fumio Tanaka
    • 1
  • Koichi Taira
    • 1
  • Noriko Kamata
    • 1
  • Hirokazu Yamagami
    • 1
  • Tetsuya Tanigawa
    • 1
  • Masatsugu Shiba
    • 1
    • 2
  • Toshio Watanabe
    • 1
  • Yasuhiro Fujiwara
    • 1
  1. 1.Department of GastroenterologyOsaka City University Graduate School of MedicineOsakaJapan
  2. 2.Department of Medical StatisticsOsaka City University Graduate School of MedicineOsakaJapan

Personalised recommendations