Kang DH, Choi CW, Kim HW, Park SB, Kim SJ, Nam HS, Ryu DG. Predictors of upstage diagnosis after endoscopic resection of gastric low-grade dysplasia.
Surg Endosc 2017;
32:2732-2738. [PMID:
29214514 DOI:
10.1007/s00464-017-5971-5]
[Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 10/29/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND
The optimal management of precursor lesions such as gastric low-grade dysplasia is crucial in order to improve gastric cancer-related mortality. However, there are no universally accepted management guidelines regarding which lesions should be resected or should be monitored by follow-up visits.
PATIENTS AND METHODS
We retrospectively analyzed data from 1006 gastric low-grade dysplasia lesions that had been resected via endoscopic submucosal dissection. We also evaluated the endoscopic risk factors associated with upstage diagnosis from low-grade dysplasia to high-grade dysplasia or gastric cancer.
RESULTS
The mean age of our patients was 63.7 ± 9.1 years and 70.3% of our study population included men. The predominant location and gross type of lesions was the lower third of the stomach (78.6%) and the elevated type (57.8%), respectively. The rates of pathological concordance, upstage, and downstage diagnosis were 85.3, 12.1, and 2.6%, respectively. Multivariate analysis, after adjusting for age and sex, showed that a lesion size ≥ 10 mm (Odds ratio [OR] 2.231; p = 0.003), erythema (OR 7.315; p < 0.001), nodularity (OR 5.589; p < 0.001), depression (OR 3.024; p = 0.002), and erosion (OR 7.680; p < 0.001) were all factors significantly associated with upstage diagnosis. Furthermore, an increasing number of risk factors was associated with an increasing frequency of upstage diagnosis; if there were no risk factors, then there was no upstage diagnosis.
CONCLUSIONS
This study identified several risk factors that were significantly associated with the upstage diagnosis of gastric low-grade dysplasia: lesion size ≥ 10 mm and a variety of surface changes (erythema, nodularity, depression, and erosion). Our data indicate that if there is no evidence of these endoscopic risk factors, then regular follow-up may be considered, according to the patient's combined comorbid conditions.
Collapse