Incidence and treatment outcomes of metachronous gastric cancer occurring after curative endoscopic submucosal dissection of undifferentiated-type early gastric cancer: Japan Clinical Oncology Group study—post hoc analysis of JCOG1009/1010,Gastric Cancer

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Incidence and treatment outcomes of metachronous gastric cancer occurring after curative endoscopic submucosal dissection of undifferentiated-type early gastric cancer: Japan Clinical Oncology Group study—post hoc analysis of JCOG1009/1010
Gastric Cancer ( IF 6.0 ) Pub Date : 2021-03-31 , DOI: 10.1007/s10120-021-01183-8
Seiichiro Abe ₁ , Kohei Takizawa ₂ , Ichiro Oda ₁ , Junki Mizusawa ₃ , Tomohiro Kadota ₃ , Hiroyuki Ono ₂ , Noriaki Hasuike ₄ , Tomonori Yano ₅ , Yoshinobu Yamamoto ₆ , Yusuke Horiuchi ₇ , Shinji Nagata ₈ , Takaki Yoshikawa ₉ , Masanori Terashima ₁₀ , Manabu Muto ₁₁

Affiliation

Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan.
Hasuike Clinic, Kobe, Japan.
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan.
Department of Gastroenterology, Hyogo Cancer Center, Hyogo, Japan.
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
Gastric Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Background and aims

A drawback of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is the development of metachronous gastric cancer (MGC). While MGC after ESD for differentiated-type (D-) EGC was well understood, little is known about MGC occurring after ESD for undifferentiated-type (UD-) EGC, because ESD had not been indicated. We evaluated the incidence and treatment outcomes of MGC after ESD of UD-EGC.

Methods

This study is a post hoc analysis of JCOG1009/1010, a multicenter trial to evaluate the efficacy and safety of ESD for UD-EGC. The patients who underwent curative ESD of index solitary UD-EGC were analyzed. Surveillance endoscopy was performed biannually for the first 3 years and thereafter annually. We assessed the time to MGC occurrence after ESD, lesion characteristics, and treatment outcomes of MGC. Time to MGC occurrence was estimated by cumulative incidence function, with death and total gastrectomy as competing risks.

Results

A total of 198 patients were included in this study. During a median follow-up period of 5.8 years, 4 patients (2%) developed MGC. Median time to MGC occurrence was 4.5 years (range: 3.1–5.4). Five-year cumulative incidence of MGC was 1.0% (95% CI: 0.2–3.3%). Two MGCs were histologically D-EGC, and the remaining two were UD-EGC. The median tumor size of MGCs was 1.0 cm (range: 0.7–1.7), and the depth of invasion (M/SM1/SM2) was 2/1/1, respectively. Three patients achieved curative resection with repeated ESD.

Conclusions

MGC does not occur commonly after curative ESD of UD-EGC, and repeated ESD could contribute to stomach preservation.

中文翻译：

未分化型早期胃癌根治性内镜黏膜下剥离术后异时性胃癌的发病率和治疗结果：日本临床肿瘤学组研究——JCOG1009/1010 的事后分析

背景和目标

用于早期胃癌 (EGC) 的内镜黏膜下剥离术 (ESD) 的一个缺点是异时性胃癌 (MGC) 的发展。虽然对分化型 (D-) EGC ESD 后的 MGC 有很好的了解，但对于未分化型 (UD-) EGC ESD 后发生的 MGC 知之甚少，因为未指出 ESD。我们评估了 UD-EGC ESD 后 MGC 的发生率和治疗结果。

方法

本研究是 JCOG1009/1010 的事后分析，这是一项评估 ESD 对 UD-EGC 的疗效和安全性的多中心试验。分析了接受治愈性ESD的指数孤立UD-EGC的患者。前 3 年每两年进行一次内窥镜检查，之后每年进行一次。我们评估了 ESD 后 MGC 发生的时间、病变特征和 MGC 的治疗结果。通过累积发病率函数估计 MGC 发生的时间，死亡和全胃切除术是竞争风险。

结果

本研究共纳入 198 名患者。在 5.8 年的中位随访期间，4 名患者 (2%) 发生 MGC。MGC 发生的中位时间为 4.5 年（范围：3.1-5.4）。MGC 的 5 年累积发病率为 1.0%（95% CI：0.2-3.3%）。两个 MGC 在组织学上是 D-EGC，其余两个是 UD-EGC。MGCs的中位肿瘤大小为1.0 cm（范围：0.7-1.7），浸润深度（M/SM1/SM2）分别为2/1/1。三名患者通过反复 ESD 实现了治愈性切除。