Long-term outcomes of endoscopic submucosal dissection versus surgery in early gastric cancer meeting expanded indication including undifferentiated-type tumors: a criteria-based ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017-10-19

AUTHORS

Sunpyo Lee, Kee Don Choi, Minkyu Han, Hee Kyong Na, Ji Yong Ahn, Kee Wook Jung, Jeong Hoon Lee, Do Hoon Kim, Ho June Song, Gin Hyug Lee, Jeong-Hwan Yook, Byung Sik Kim, Hwoon-Yong Jung

ABSTRACT

BackgroundEndoscopic submucosal dissection (ESD) for early gastric cancer (EGC) meeting the expanded indication is considered investigational. We aimed to compare long-term outcomes of ESD and surgery for EGC in the expanded indication based on each criterion.MethodsThis study included 1823 consecutive EGC patients meeting expanded indication conditions and treated at a tertiary referral center: 916 and 907 patients underwent surgery or ESD, respectively. The expanded indication included four discrete criteria: (I) intramucosal differentiated tumor, without ulcers, size >2 cm; (II) intramucosal differentiated tumor, with ulcers, size ≤3 cm; (III) intramucosal undifferentiated tumor, without ulcers, size ≤2 cm; and (IV) submucosal invasion <500 μm (sm1), differentiated tumor, size ≤3 cm. We selected 522 patients in each group by propensity score matching and retrospectively evaluated each group. The primary outcome was overall survival (OS); the secondary outcomes were disease-specific survival (DSS), recurrence-free survival (RFS), and treatment-related complications.ResultsIn all patients and subgroups meeting each criterion, OS and DSS were not significantly different between groups (OS and DSS, all patients: p = 0.354 and p = 0.930; criteria I: p = 0.558 and p = 0.688; criterion II: p = 1.000 and p = 1.000; criterion III: p = 0.750 and p = 0.799; and criterion IV: p = 0.599 and p = 0.871). RFS, in all patients and criterion I, was significantly shorter in the ESD group than in the surgery group (p < 0.001 and p < 0.003, respectively). The surgery group showed higher rates of late and severe treatment-related complications than the ESD group.ConclusionsESD may be an alternative treatment option to surgery for EGCs meeting expanded indications, including undifferentiated-type tumors. More... »

PAGES

490-499

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s10120-017-0772-z

DOI

http://dx.doi.org/10.1007/s10120-017-0772-z

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1092291993

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/29052052


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    "description": "BackgroundEndoscopic submucosal dissection (ESD) for early gastric cancer (EGC) meeting the expanded indication is considered investigational. We aimed to compare long-term outcomes of ESD and surgery for EGC in the expanded indication based on each criterion.MethodsThis study included 1823 consecutive EGC patients meeting expanded indication conditions and treated at a tertiary referral center: 916 and 907 patients underwent surgery or ESD, respectively. The expanded indication included four discrete criteria: (I) intramucosal differentiated tumor, without ulcers, size\u00a0>2\u00a0cm; (II) intramucosal differentiated tumor, with ulcers, size\u00a0\u22643\u00a0cm; (III) intramucosal undifferentiated tumor, without ulcers, size\u00a0\u22642\u00a0cm; and (IV) submucosal invasion\u00a0<500\u00a0\u03bcm (sm1), differentiated tumor, size\u00a0\u22643\u00a0cm. We selected 522 patients in each group by propensity score matching and retrospectively evaluated each group. The primary outcome was overall survival (OS); the secondary outcomes were disease-specific survival (DSS), recurrence-free survival (RFS), and treatment-related complications.ResultsIn all patients and subgroups meeting each criterion, OS and DSS were not significantly different between groups (OS and DSS, all patients: p\u00a0=\u00a00.354 and p\u00a0=\u00a00.930; criteria I: p\u00a0=\u00a00.558 and p\u00a0=\u00a00.688; criterion II: p\u00a0=\u00a01.000 and p\u00a0=\u00a01.000; criterion III: p\u00a0=\u00a00.750 and p\u00a0=\u00a00.799; and criterion IV: p\u00a0=\u00a00.599 and p\u00a0=\u00a00.871). RFS, in all patients and criterion I, was significantly shorter in the ESD group than in the surgery group (p\u00a0<\u00a00.001 and p\u00a0<\u00a00.003, respectively). The surgery group showed higher rates of late and severe treatment-related complications than the ESD group.ConclusionsESD may be an alternative treatment option to surgery for EGCs meeting expanded indications, including undifferentiated-type tumors.", 
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27 schema:description BackgroundEndoscopic submucosal dissection (ESD) for early gastric cancer (EGC) meeting the expanded indication is considered investigational. We aimed to compare long-term outcomes of ESD and surgery for EGC in the expanded indication based on each criterion.MethodsThis study included 1823 consecutive EGC patients meeting expanded indication conditions and treated at a tertiary referral center: 916 and 907 patients underwent surgery or ESD, respectively. The expanded indication included four discrete criteria: (I) intramucosal differentiated tumor, without ulcers, size >2 cm; (II) intramucosal differentiated tumor, with ulcers, size ≤3 cm; (III) intramucosal undifferentiated tumor, without ulcers, size ≤2 cm; and (IV) submucosal invasion <500 μm (sm1), differentiated tumor, size ≤3 cm. We selected 522 patients in each group by propensity score matching and retrospectively evaluated each group. The primary outcome was overall survival (OS); the secondary outcomes were disease-specific survival (DSS), recurrence-free survival (RFS), and treatment-related complications.ResultsIn all patients and subgroups meeting each criterion, OS and DSS were not significantly different between groups (OS and DSS, all patients: p = 0.354 and p = 0.930; criteria I: p = 0.558 and p = 0.688; criterion II: p = 1.000 and p = 1.000; criterion III: p = 0.750 and p = 0.799; and criterion IV: p = 0.599 and p = 0.871). RFS, in all patients and criterion I, was significantly shorter in the ESD group than in the surgery group (p < 0.001 and p < 0.003, respectively). The surgery group showed higher rates of late and severe treatment-related complications than the ESD group.ConclusionsESD may be an alternative treatment option to surgery for EGCs meeting expanded indications, including undifferentiated-type tumors.
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33 schema:keywords BackgroundEndoscopic submucosal dissection
34 ConclusionsESD
35 ESD
36 ESD group
37 MethodsThis study
38 ResultsIn
39 Secondary outcomes
40 alternative treatment option
41 analysis
42 cancer
43 cancer meetings
44 center
45 complications
46 conditions
47 criteria
48 criteria I
49 criteria-based analysis
50 differentiated tumors
51 discrete criteria
52 disease-specific survival
53 dissection
54 early gastric cancer
55 endoscopic submucosal dissection
56 gastric cancer
57 group
58 high rate
59 indications
60 invasion
61 long-term outcomes
62 meeting
63 options
64 outcomes
65 overall survival
66 patients
67 patients meeting
68 primary outcome
69 propensity
70 rate
71 recurrence-free survival
72 referral center
73 severe treatment-related complications
74 size
75 study
76 subgroups
77 submucosal dissection
78 submucosal invasion
79 surgery
80 surgery group
81 survival
82 tertiary referral center
83 treatment options
84 treatment-related complications
85 tumors
86 ulcers
87 undifferentiated tumors
88 undifferentiated-type tumors
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