Background

Endoscopy could help detect early gastric cancer (EGC) and improve the prognosis of patients. The aim of this study was to analyze the impact of endoscopy and endoscopic surveillance on the early detection of gastric cancer (GC), GC staging, and treatment selection.

Methods

Patients with GC diagnosed at our center from 2010 to 2022 were retrospectively analyzed and allocated to the short-interval group (had received endoscopy within 3 years before diagnosis), the long-interval group (had received endoscopy more than 3 years before diagnosis), and the unchecked group (had not received endoscopy before diagnosis). The differences in GC staging and treatment modalities among the three groups were analyzed, and the differences in the clinical and pathological features of EGC were further analyzed.

Results

One thousand and twenty-five GC patients were included, with 395 cases of EGC and 630 cases of advanced GC. The proportions of EGC in the short-interval, long-interval, and unchecked groups were 98.0%, 84.2%, and 29.8%, respectively (p < 0.001). Among the 387 lesions of 367 EGC patients were resected by endoscopic submucosal dissection (ESD), 341 (88.1%) exhibited curative resection, and 46 (11.9%) involved noncurative resections. Lesions of EGC differed significantly in diameter, depth of invasion, and curative resection rate (p = 0.033, 0.019, and 0.005, respectively). In the short-interval group, 87.8% of the lesions were ≤ 2 cm, 95.6% of the invasion depths were confined to the mucosal layer, and 96.7% of the eCura scores were A or B. Compared with the unchecked group, they had smaller diameters (RR = 0.419, 95% CI 0.234–0.752), shallower invasion depths (RR = 0.286, 95% CI 0.105–0.777), and a higher curative resection rate (RR = 0.215, 95% CI 0.068–0.676).

Conclusion

Endoscopic surveillance at 3-year intervals can help detect EGC, and the EGC lesions found have smaller diameters and shallower depths of invasion, helping improve the curative resection rate of ESD.

Graphical abstract

中文翻译：

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内镜监测对胃癌早期诊断和内镜切除可能性的影响

背景

内窥镜检查有助于发现早期胃癌（EGC）并改善患者的预后。本研究的目的是分析内窥镜检查和内窥镜监测对胃癌 (GC) 早期检测、GC 分期和治疗选择的影响。

方法

回顾性分析2010年至2022年在我中心诊断的GC患者，并将其分为短间隔组（诊断前3年内接受过内镜检查）、长间隔组（诊断前3年以上接受过内镜检查）、和未检查组（诊断前未接受内镜检查）。分析三组间GC分期和治疗方式的差异，并进一步分析EGC临床和病理特征的差异。

结果

纳入 125 例 GC 患者，其中 EGC 395 例，晚期 GC 630 例。短间隔组、长间隔组和未检查组中 EGC 的比例分别为 98.0%、84.2% 和 29.8%（p  < 0.001）。在367例EGC患者的387个病灶中，通过内镜粘膜下剥离术（ESD）切除了341例（88.1％）的病灶，46例（11.9％）进行了非治愈性切除。EGC 病灶在直径、浸润深度和治愈性切除率方面存在显着差异（分别为p  = 0.033、0.019 和 0.005）。短间隔组中，87.8%的病灶≤2 cm，95.6%的浸润深度局限于粘膜层，96.7%的eCura评分为A或B。与未检查组相比，较小的直径（RR = 0.419，95% CI 0.234–0.752）、较浅的浸润深度（RR = 0.286，95% CI 0.105–0.777）和较高的治愈性切除率（RR = 0.215，95% CI 0.068–0.676）。

结论

每3年一次的内镜监测有助于发现EGC，且发现的EGC病灶直径较小、浸润深度较浅，有利于提高ESD的根治性切除率。

图形概要