Background and Aims

Cancer recurrence is observed in some patients without additional radical surgery after endoscopic submucosal dissection (ESD) that does not fulfill the curability criteria for early gastric cancer (EGC), categorized as “noncurative resection” or “curability C-2” in the guidelines. However, time to cancer recurrence is different in such patients. Thus, we aimed to identify the risk factors of early and late cancer recurrences in these patients.

Methods

Between 2000 and 2011, this multicenter study analyzed 905 patients who were followed up without additional radical surgery after ESD for EGC categorized as curability C-2. We evaluated the risk factors for early and late cancer recurrences, separately, after ESD. The cut-off value was defined at 2 years.

Results

Time to cancer recurrence in the enrolled patients showed a bimodal pattern, and the 5-year cancer recurrence rate was 3.2%. Multivariate Cox analyses revealed that lymphatic invasion (hazard ratio [HR], 8.56; P = .003) was the sole independent risk factor for early cancer recurrence. Regarding late cancer recurrence, vascular invasion (HR, 4.50; P = .039) was an independent risk factor, and lymphatic invasion tended to be a risk factor (HR, 3.63; P = .069).

Conclusions

This multicenter study with a large cohort demonstrated that lymphatic invasion is mainly associated with early cancer recurrence; however, vascular invasion was a risk factor only for late recurrence in patients without additional treatment after ESD for EGC categorized as curability C-2. This finding may contribute to decision making for treatment strategies after ESD, especially for patients with a relatively short life expectancy.

中文翻译：

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早期胃癌非根治性内镜黏膜下剥离术后无需额外手术的早期和晚期癌症复发的不同危险因素

背景和目标

在某些不满足早期胃癌（EGC）治愈标准的内镜黏膜下剥离术（ESD）术后未进行额外根治性手术的患者中，观察到癌症复发，在指南中归类为“非治愈性切除术”或“可治愈性C-2”。但是，这类患者的癌症复发时间不同。因此，我们旨在确定这些患者早期和晚期癌症复发的危险因素。

方法

在2000年至2011年之间，这项多中心研究分析了905例经ESD治疗的EGC患者，无需额外的根治性手术，其随访结果为C-2。我们分别评估了ESD后早期和晚期癌症复发的危险因素。临界值定义为2年。

结果

入组患者的癌症复发时间呈双峰模式，且5年癌症复发率为3.2％。多元Cox分析显示，淋巴管浸润（危险比[HR]为8.56；P  = 0.003）是早期癌症复发的唯一独立危险因素。对于晚期癌症复发，血管浸润（HR，4.50；P  = .039）是一个独立的危险因素，而淋巴管浸润则是一个危险因素（HR，3.63；P  = .069）。

结论

这项涉及大量研究的多中心研究表明，淋巴管浸润主要与早期癌症复发有关。然而，对于EGC分类为可治愈C-2的ESD，在没有额外治疗的情况下，血管浸润仅是晚期复发患者的危险因素。这一发现可能有助于对ESD后的治疗策略做出决策，特别是对于预期寿命相对较短的患者。