Long-term Survival After Endoscopic Resection For Gastric Cancer: Real-world Evidence From a Multicenter Prospective Cohort,Clinical Gastroenterology and Hepatology

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Long-term Survival After Endoscopic Resection For Gastric Cancer: Real-world Evidence From a Multicenter Prospective Cohort
Clinical Gastroenterology and Hepatology ( IF 12.6 ) Pub Date : 2022-08-07 , DOI: 10.1016/j.cgh.2022.07.029
Haruhisa Suzuki ₁ , Hiroyuki Ono ₂ , Toshiaki Hirasawa ₃ , Yoji Takeuchi ₄ , Kenji Ishido ₅ , Shu Hoteya ₆ , Tomonori Yano ₇ , Shinji Tanaka ₈ , Yosuke Toya ₉ , Masahiro Nakagawa ₁₀ , Takashi Toyonaga ₁₁ , Kenichi Takemura ₁₂ , Kingo Hirasawa ₁₃ , Mitsuru Matsuda ₁₄ , Hironori Yamamoto ₁₅ , Yosuke Tsuji ₁₆ , Satoru Hashimoto ₁₇ , Maeda Yuki ₂ , Tsuneo Oyama ₁₈ , Ryuta Takenaka ₁₉ , Yoshinobu Yamamoto ₂₀ , Yuji Naito ₂₁ , Katsumi Yamamoto ₂₂ , Nozomu Kobayashi ₂₃ , Yoshiro Kawahara ₂₄ , Masaaki Hirano ₂₅ , Shigeto Koizumi ₂₆ , Shinichiro Hori ₂₇ , Masahiro Tajika ₂₈ , Takuto Hikichi ₂₉ , Kenshi Yao ₃₀ , Chizu Yokoi ₃₁ , Ken Ohnita ₃₂ , Yasuhiro Hisanaga ₃₃ , Tetsuya Sumiyoshi ₃₄ , Shinji Kitamura ₃₅ , Hisao Tanaka ₃₆ , Ryo Shimoda ₃₇ , Taichi Shimazu ₃₈ , Kohei Takizawa ₂ , Satoshi Tanabe ₃₉ , Hitoshi Kondo ₃₄ , Hiroyasu Iishi ₄₀ , Motoki Ninomiya ₄₁ , Ichiro Oda ₁ ,

Affiliation

Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan.
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan.
Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan.
Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.
Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
Department of Endoscopy, Kobe University Hospital, Kobe, Japan.
Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan.
Department of Gastroenterology, Toyama Prefectural Central Hospital, Toyama, Japan.
Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan.
Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan.
Department of Gastroenterology, Tsuyama Chuo Hospital, Tsuyama, Japan.
Department of Gastroenterological Oncology, Hyogo Cancer Center, Akashi, Japan.
Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan.
Department of Gastroenterology, Tochigi Cancer Center, Utsunomiya, Japan.
Department of Practical Gastrointestinal Endoscopy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Department of Internal Medicine, Keinan General Hospital, Niigata, Japan.
Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan.
Department of Gatroenterology, National Hospital Organization Shikoku Cancer Center, Matuyama, Japan.
Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan.
Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.
Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan.
Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.
Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
Department of Gastroenterology, Tonan Hospital, Sapporo, Japan.
Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
Division of Gastroenterology, Tottori Red Cross Hospital, Tottori, Japan.
Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan.
Behavioral Science Division, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
Department of Advanced Medicine, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan.
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan; Department of Gastroenterology, Itami City Hospital, Itami, Japan.
Digestive Disease Center, Yuuai Medical Center, Okinawa, Japan.

Background & Aims

We aimed to clarify the long-term outcomes of endoscopic resection (ER) for early gastric cancers (EGCs) based on pathological curability in a multicenter prospective cohort study.

Methods

We analyzed the long-term outcomes of 9054 patients with 10,021 EGCs undergoing ER between July 2010 and June 2012. Primary endpoint was the 5-year overall survival (OS). The hazard ratio for all-cause mortality was calculated using the Cox proportional hazards model. We also compared the 5-year OS with the expected one calculated for the surgically resected patients with EGC. If the lower limit of the 95% confidence interval (CI) of the 5-year OS exceeded the expected 5-year OS minus a margin of 5% (threshold 5-year OS), ER was considered to be effective. Pathological curability was categorized into en bloc resection, negative margins, and negative lymphovascular invasion: differentiated-type, pT1a, ulcer negative, ≤2 cm (Category A1); differentiated-type, pT1a, ulcer negative, >2 cm or ulcer positive, ≤3 cm (Category A2); undifferentiated-type, pT1a, ulcer negative, ≤2 cm (Category A3); differentiated-type, pT1b (SM1), ≤3 cm (Category B); or noncurative resections (Category C).

Results

Overall, the 5-year OS was 89.0% (95% CI, 88.3%–89.6%). In a multivariate analysis, no significant differences were observed when the hazard ratio of Categories A2, A3, and B were compared with that of A1. In all the pathological curability categories, the lower limit of the 95% CI for the 5-year OS exceeded the threshold 5-year OS.

Conclusion

ER can be recommended as a standard treatment for patients with EGCs fulfilling Category A2, A3, and B, as well as A1 (UMIN Clinical Trial Registry, UMIN000005871).

中文翻译：

胃癌内镜下切除术后的长期生存：来自多中心前瞻性队列的真实世界证据

背景与目标

我们的目的是在多中心前瞻性队列研究中阐明基于病理可治愈性的早期胃癌 (EGC) 内镜切除术 (ER) 的长期结果。

方法

我们分析了 2010 年 7 月至 2012 年 6 月期间接受 ER 的 9054 名患者的长期结果，其中 10,021 个 EGC。主要终点是 5 年总生存期 (OS)。使用 Cox 比例风险模型计算全因死亡率的风险比。我们还将 5 年 OS 与为手术切除的 EGC 患者计算的预期 OS 进行了比较。如果 5 年 OS 的 95% 置信区间 (CI) 下限超过预期 5 年 OS 减去 5% 的差值（5 年 OS 阈值），则认为 ER 有效。病理治愈分为整块切除、切缘阴性、淋巴血管浸润阴性：分化型、pT1a、溃疡阴性、≤2cm（A1类）；分化型，pT1a，溃疡阴性，>2 cm 或溃疡阳性，≤3 cm（A2 类）；未分化型，pT1a，溃疡阴性，≤2 cm（A3 类）；分化型，pT1b (SM1)，≤3 cm（B 类）；或非治愈性切除术（C 类）。