Novel risk stratification for metachronous recurrence after curative endoscopic submucosal dissection for early gastric cancer

Hyo Joon Yang, Sang Gyun Kim, Joo Hyun Lim, Ji Min Choi, Sooyeon Oh, Jae Yong Park, Seung Jun Han, Jung Kim, Hyunsoo Chung, Hyun Chae Jung

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background and Aims: This study stratified the risk of developing metachronous gastric cancer (MGC) after curative endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) to enable customization of endoscopic surveillance for MGC. Methods: A total of 1115 patients who underwent curative ESD based on the expanded criteria for differentiated EGC from 2005 to 2014 at a single tertiary hospital were enrolled in this retrospective cohort study. They were followed up with annual endoscopy for a median of 50.1 months. Helicobacter pylori and histologic intestinal metaplasia (IM) were evaluated. The Kaplan-Meier method and Cox regression analysis were used for risk stratification. Results: Three risk groups were identified: group 1 comprised patients with a synchronous neoplasm; group 2 comprised male patients with corpus IM; and group 3 comprised male patients without corpus IM or female patients. The 5- and 7-year cumulative risks (95% confidence interval [CI]) for metachronous recurrence were 15.1% (95% CI, 7.7-22.5) and 26.1% (95% CI, 14.9-37.3), respectively, in group 1; 5.6% (95% CI, 3.1-8.1) and 9.3% (95% CI, 5.4-13.2), respectively, in group 2; and 3.8% (95% CI, 1.6-6.0) and 4.9% (95% CI, 2.4-7.4), respectively, in group 3 (P <.001 by log-rank test). The incidence of MGCs increased constantly even after 5 years in groups 1 and 2 but not in group 3. There was not enough evidence to show an association between H pylori eradication and metachronous recurrence in the data. Conclusions: Meticulous annual endoscopic surveillance for MGC for more than 5 years is recommended for patients with synchronous neoplasm. Endoscopic surveillance may also be extended beyond 5 years in male patients with corpus IM.

Original languageEnglish
Pages (from-to)419-428.e3
JournalGastrointestinal Endoscopy
Volume87
Issue number2
DOIs
StatePublished - 1 Feb 2018

Fingerprint

Stomach Neoplasms
Confidence Intervals
Recurrence
Metaplasia
Multiple Primary Neoplasms
Pylorus
Endoscopic Mucosal Resection
Tertiary Care Centers
Helicobacter pylori
Endoscopy
Cohort Studies
Retrospective Studies
Regression Analysis
Incidence

Cite this

@article{662b8f041f334755bafe2448a6ea1438,
title = "Novel risk stratification for metachronous recurrence after curative endoscopic submucosal dissection for early gastric cancer",
abstract = "Background and Aims: This study stratified the risk of developing metachronous gastric cancer (MGC) after curative endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) to enable customization of endoscopic surveillance for MGC. Methods: A total of 1115 patients who underwent curative ESD based on the expanded criteria for differentiated EGC from 2005 to 2014 at a single tertiary hospital were enrolled in this retrospective cohort study. They were followed up with annual endoscopy for a median of 50.1 months. Helicobacter pylori and histologic intestinal metaplasia (IM) were evaluated. The Kaplan-Meier method and Cox regression analysis were used for risk stratification. Results: Three risk groups were identified: group 1 comprised patients with a synchronous neoplasm; group 2 comprised male patients with corpus IM; and group 3 comprised male patients without corpus IM or female patients. The 5- and 7-year cumulative risks (95{\%} confidence interval [CI]) for metachronous recurrence were 15.1{\%} (95{\%} CI, 7.7-22.5) and 26.1{\%} (95{\%} CI, 14.9-37.3), respectively, in group 1; 5.6{\%} (95{\%} CI, 3.1-8.1) and 9.3{\%} (95{\%} CI, 5.4-13.2), respectively, in group 2; and 3.8{\%} (95{\%} CI, 1.6-6.0) and 4.9{\%} (95{\%} CI, 2.4-7.4), respectively, in group 3 (P <.001 by log-rank test). The incidence of MGCs increased constantly even after 5 years in groups 1 and 2 but not in group 3. There was not enough evidence to show an association between H pylori eradication and metachronous recurrence in the data. Conclusions: Meticulous annual endoscopic surveillance for MGC for more than 5 years is recommended for patients with synchronous neoplasm. Endoscopic surveillance may also be extended beyond 5 years in male patients with corpus IM.",
author = "Yang, {Hyo Joon} and Kim, {Sang Gyun} and Lim, {Joo Hyun} and Choi, {Ji Min} and Sooyeon Oh and Park, {Jae Yong} and Han, {Seung Jun} and Jung Kim and Hyunsoo Chung and Jung, {Hyun Chae}",
year = "2018",
month = "2",
day = "1",
doi = "10.1016/j.gie.2017.07.005",
language = "English",
volume = "87",
pages = "419--428.e3",
journal = "Gastrointestinal endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "2",

}

Novel risk stratification for metachronous recurrence after curative endoscopic submucosal dissection for early gastric cancer. / Yang, Hyo Joon; Kim, Sang Gyun; Lim, Joo Hyun; Choi, Ji Min; Oh, Sooyeon; Park, Jae Yong; Han, Seung Jun; Kim, Jung; Chung, Hyunsoo; Jung, Hyun Chae.

In: Gastrointestinal Endoscopy, Vol. 87, No. 2, 01.02.2018, p. 419-428.e3.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Novel risk stratification for metachronous recurrence after curative endoscopic submucosal dissection for early gastric cancer

AU - Yang, Hyo Joon

AU - Kim, Sang Gyun

AU - Lim, Joo Hyun

AU - Choi, Ji Min

AU - Oh, Sooyeon

AU - Park, Jae Yong

AU - Han, Seung Jun

AU - Kim, Jung

AU - Chung, Hyunsoo

AU - Jung, Hyun Chae

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Background and Aims: This study stratified the risk of developing metachronous gastric cancer (MGC) after curative endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) to enable customization of endoscopic surveillance for MGC. Methods: A total of 1115 patients who underwent curative ESD based on the expanded criteria for differentiated EGC from 2005 to 2014 at a single tertiary hospital were enrolled in this retrospective cohort study. They were followed up with annual endoscopy for a median of 50.1 months. Helicobacter pylori and histologic intestinal metaplasia (IM) were evaluated. The Kaplan-Meier method and Cox regression analysis were used for risk stratification. Results: Three risk groups were identified: group 1 comprised patients with a synchronous neoplasm; group 2 comprised male patients with corpus IM; and group 3 comprised male patients without corpus IM or female patients. The 5- and 7-year cumulative risks (95% confidence interval [CI]) for metachronous recurrence were 15.1% (95% CI, 7.7-22.5) and 26.1% (95% CI, 14.9-37.3), respectively, in group 1; 5.6% (95% CI, 3.1-8.1) and 9.3% (95% CI, 5.4-13.2), respectively, in group 2; and 3.8% (95% CI, 1.6-6.0) and 4.9% (95% CI, 2.4-7.4), respectively, in group 3 (P <.001 by log-rank test). The incidence of MGCs increased constantly even after 5 years in groups 1 and 2 but not in group 3. There was not enough evidence to show an association between H pylori eradication and metachronous recurrence in the data. Conclusions: Meticulous annual endoscopic surveillance for MGC for more than 5 years is recommended for patients with synchronous neoplasm. Endoscopic surveillance may also be extended beyond 5 years in male patients with corpus IM.

AB - Background and Aims: This study stratified the risk of developing metachronous gastric cancer (MGC) after curative endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) to enable customization of endoscopic surveillance for MGC. Methods: A total of 1115 patients who underwent curative ESD based on the expanded criteria for differentiated EGC from 2005 to 2014 at a single tertiary hospital were enrolled in this retrospective cohort study. They were followed up with annual endoscopy for a median of 50.1 months. Helicobacter pylori and histologic intestinal metaplasia (IM) were evaluated. The Kaplan-Meier method and Cox regression analysis were used for risk stratification. Results: Three risk groups were identified: group 1 comprised patients with a synchronous neoplasm; group 2 comprised male patients with corpus IM; and group 3 comprised male patients without corpus IM or female patients. The 5- and 7-year cumulative risks (95% confidence interval [CI]) for metachronous recurrence were 15.1% (95% CI, 7.7-22.5) and 26.1% (95% CI, 14.9-37.3), respectively, in group 1; 5.6% (95% CI, 3.1-8.1) and 9.3% (95% CI, 5.4-13.2), respectively, in group 2; and 3.8% (95% CI, 1.6-6.0) and 4.9% (95% CI, 2.4-7.4), respectively, in group 3 (P <.001 by log-rank test). The incidence of MGCs increased constantly even after 5 years in groups 1 and 2 but not in group 3. There was not enough evidence to show an association between H pylori eradication and metachronous recurrence in the data. Conclusions: Meticulous annual endoscopic surveillance for MGC for more than 5 years is recommended for patients with synchronous neoplasm. Endoscopic surveillance may also be extended beyond 5 years in male patients with corpus IM.

UR - http://www.scopus.com/inward/record.url?scp=85028892428&partnerID=8YFLogxK

U2 - 10.1016/j.gie.2017.07.005

DO - 10.1016/j.gie.2017.07.005

M3 - Article

C2 - 28713064

AN - SCOPUS:85028892428

VL - 87

SP - 419-428.e3

JO - Gastrointestinal endoscopy

JF - Gastrointestinal endoscopy

SN - 0016-5107

IS - 2

ER -