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Zhu X, Ge B, Wen L, Huang H, Shi X. Analysis of multiple factors influencing the survival of patients with advanced gastric cancer. Aging (Albany NY) 2024; 16:8541-8551. [PMID: 38742950 PMCID: PMC11164492 DOI: 10.18632/aging.205820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/08/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The aim of this study was to investigate the main factors influencing the survival of patients with advanced gastric cancer. METHODS The clinicopathological data of 120 patients with advanced gastric cancer were analyzed retrospectively, and clinical and pathological data were collected. Tumor tissue staging and grading were re-evaluated, and 5-year overall survival was followed up. The classified data were described by percentages, and the continuous data were described by standard deviations or medians. Univariate analysis was performed using the χ2 test or rank-sum test, followed by Kaplan-Meier survival analysis to calculate the median survival time and 5-year cumulative survival. A multivariate Cox regression model was used to evaluate the independent risk factors affecting survival. The test level was α = 0.05. RESULTS Patients were followed up for 0 to 60 months, the 5-year overall survival rate was 36.2%, and the median survival time was 53.0 ± 1.461 months. K-M and log-rank test results revealed that tumor location, degree of differentiation, depth of invasion, regional lymph node involvement, and postoperative tumor stage were correlated with a decreased 5-year survival rate (P < 0.05). A multivariate Cox risk regression model was used to analyze the degree of histological differentiation (HR = 1.441; 95% CI = 1.049-1.979; P = 0.024), regional lymph node (HR = 1.626; 95% CI = 1.160-2.279; P = 0.005), and pTNM stage (HR = 2.266; 95% CI = 1.335-3.847; P = 0.002), which are independent risk factors for poor survival. Tumor location (P = 0.191), invasion depth (P = 0.579) and tumor size (P = 0.324) were not found to be independent risk factors. CONCLUSION The degree of tumor differentiation, regional lymph node metastasis and postoperative pathological stage were found to be independent risk factors for 5-year overall survival in patients with advanced gastric cancer. Standardized and reasonable lymph node dissection and accurate postoperative pathological staging were very important.
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Affiliation(s)
- Xinqiang Zhu
- The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu 223800, PR China
- Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212000, PR China
| | - Beibei Ge
- The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu 223800, PR China
| | - Linchun Wen
- The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu 223800, PR China
| | - Hailong Huang
- The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu 223800, PR China
| | - Xiaohong Shi
- The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu 223800, PR China
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Dal Cero M, Bencivenga M, Liu DHW, Sacco M, Alloggio M, Kerckhoffs KGP, Filippini F, Saragoni L, Iglesias M, Tomezzoli A, Carneiro F, Grabsch HI, Verlato G, Torroni L, Piessen G, Pera M, de Manzoni G. Clinical Features of Gastric Signet Ring Cell Cancer: Results from a Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:5191. [PMID: 37958365 PMCID: PMC10647446 DOI: 10.3390/cancers15215191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Conflicting results about the prognostic relevance of signet ring cell histology in gastric cancer have been reported. We aimed to perform a meta-analysis focusing on the clinicopathological features and prognosis of this subgroup of cancer compared with other histologies. METHODS A systematic literature search in the PubMed database was conducted, including all publications up to 1 October 2021. A meta-analysis comparing the results of the studies was performed. RESULTS A total of 2062 studies referring to gastric cancer with signet ring cell histology were identified, of which 262 studies reported on its relationship with clinical information. Of these, 74 were suitable to be included in the meta-analysis. A slightly lower risk of developing nodal metastases in signet ring cell tumours compared to other histotypes was found (especially to undifferentiated/poorly differentiated/mucinous and mixed histotypes); the lower risk was more evident in early and slightly increased in advanced gastric cancer. Survival tended to be better in early stage signet ring cell cancer compared to other histotypes; no differences were shown in advanced stages, and survival was poorer in metastatic patients. In the subgroup analysis, survival in signet ring cell cancer was slightly worse compared to non-signet ring cell cancer and differentiated/well-to-moderately differentiated adenocarcinoma. CONCLUSIONS Most of the conflicting results in signet ring cell gastric cancer literature could be derived from the lack of standardisation in their classification and the comparison with the different subtypes of gastric cancer. There is a critical need to strive for a standardised classification system for gastric cancer, fostering clarity and coherence in the forthcoming research and clinical applications.
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Affiliation(s)
- Mariagiulia Dal Cero
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Borgo Trento Hospital, Piazzale Stefani 1, 37124 Verona, Italy; (M.D.C.)
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM), Department of Surgery, Universitat Autònoma de Barcelona, 08003 Barcelona, Spain
| | - Maria Bencivenga
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Borgo Trento Hospital, Piazzale Stefani 1, 37124 Verona, Italy; (M.D.C.)
| | - Drolaiz H. W. Liu
- Department of Pathology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
- Institute of Clinical Pathology and Molecular Pathology, Kepler University Hospital and Johannes Kepler University, 4021 Linz, Austria
| | - Michele Sacco
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Borgo Trento Hospital, Piazzale Stefani 1, 37124 Verona, Italy; (M.D.C.)
| | - Mariella Alloggio
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Borgo Trento Hospital, Piazzale Stefani 1, 37124 Verona, Italy; (M.D.C.)
| | - Kelly G. P. Kerckhoffs
- Department of Pathology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
- Department of Pathology, VieCuri Medical Centre, 5912 BL Venlo, The Netherlands
| | - Federica Filippini
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Borgo Trento Hospital, Piazzale Stefani 1, 37124 Verona, Italy; (M.D.C.)
| | - Luca Saragoni
- Pathology Unit, Morgagni-Pierantoni Hospital, 47100 Forlì, Italy
| | - Mar Iglesias
- Department of Pathology, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Anna Tomezzoli
- Department of Pathology, Verona University Hospital, 37134 Verona, Italy
| | - Fátima Carneiro
- Department of Pathology, Medical Faculty of the University of Porto/Centro Hospitalar Universitário São João and Ipatimup/i3S, 4200-319 Porto, Portugal
| | - Heike I. Grabsch
- Department of Pathology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St. James’s, University of Leeds, Leeds LS2 9JT, UK
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37126 Verona, Italy
| | - Lorena Torroni
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37126 Verona, Italy
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Lille University Hospital, 59000 Lille, France
| | - Manuel Pera
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM), Department of Surgery, Universitat Autònoma de Barcelona, 08003 Barcelona, Spain
| | - Giovanni de Manzoni
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Borgo Trento Hospital, Piazzale Stefani 1, 37124 Verona, Italy; (M.D.C.)
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Papaefthymiou A, Kahaleh M, Lemmers A, Sferrazza S, Barret M, Yamamoto K, Deprez P, Marín-Gabriel JC, Tribonias G, Ouyang H, Barbaro F, Kiosov O, Seewald S, Patil G, Elkholy S, Coumaros D, Vuckovic C, Banks M, Haidry R, Mavrogenis G. Performance of endoscopic submucosal dissection for undifferentiated early gastric cancer: a multicenter retrospective cohort. Endosc Int Open 2023; 11:E673-E678. [PMID: 37744471 PMCID: PMC10513782 DOI: 10.1055/a-2105-1934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/31/2023] [Indexed: 09/26/2023] Open
Abstract
Background and study aims Undifferentiated early gastric cancer (UD-EGC) represents an extended indication for endoscopic submucosal dissection (ESD) based on the existing guidelines. This study evaluated the prevalence of UD-EGC recurrence after ESD, and potentially implicated risk factors. Patients and methods Data from 17 centers were collected retrospectively including demographics, endoscopic and pathological findings, and follow-up data from UD-EGC cases treated by ESD. Patients with incomplete resection or advanced disease were excluded. Descriptive statistics quantified variables and calculated the incidence of recurrence. Chi-square test was applied to assess any link between independent variables and relapse; significantly associated variables were inserted to a multivariable regression model. Results Seventy-one patients were eligible, with 2:1 female to male ratio and age of 65.8 ± 11.8 years. Mean lesion size was 33.5 ± 18.8 mm and the most frequent histological subtype was signet ring-cells UGC (2:1). Patients were followed-up every 5.6 ± 3.7 months with a mean surveillance period of 29.3 ± 15.3 months until data collection. Four patients (5.6%) developed local recurrence 8.8 ± 6.5 months post-ESD, with no lymph node or distal metastases been reported. Lesion size was not associated with recurrence ( P = 0.32), in contrast to lymphovascular and perineural invasion which were independently associated with local recurrence ( P = 0.006 and P < 0.001, respectively). Conclusions ESD could be considered as the initial step to manage UD-EGC, providing at least an "entire-lesion" biopsy to guide therapeutic strategy. When histology confirms absence of lymphovascular and perineural invasion, this modality could be therapeutic, providing low recurrence rates.
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Affiliation(s)
- Apostolis Papaefthymiou
- Endoscopy Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Michel Kahaleh
- Gastroenterology, Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, United States
| | - Arnaud Lemmers
- Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Sandro Sferrazza
- Department of Gastroenterology and Digestive Endoscopy, APSS Trento, Trento, Italy
| | - Maximilien Barret
- Gastroenterology and Digestive Oncology, Hopital Cochin, Paris, France
| | - Katsumi Yamamoto
- Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Pierre Deprez
- Cliniques Universitaires St-Luc, Université Catholique de Louvain, Louvain Medical ASBL, Bruxelles, Belgium
| | | | - George Tribonias
- Gastroenterology, General Hospital of Nikaia Peiraia Agios Panteleimon, Athens, Greece
| | - Hong Ouyang
- Endoscopy, The People's Hospital of Linan City, hangzhou, China
| | - Federico Barbaro
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Oleksandr Kiosov
- University Clinical, Zaporizhzhia State Medical University, Zaporozhye, Ukraine
| | - Stefan Seewald
- Center for Gastroenterology, Hirlanden Clinic Zurich, Zurich, Switzerland
| | | | - Shaimaa Elkholy
- Gastroenterology Division, Internal Medicine Department, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Dimitri Coumaros
- Gastroenterology Department, Clinique Sainte Barbe, Strasbourg, France
| | - Clemence Vuckovic
- Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Matthew Banks
- Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Rehan Haidry
- Gastroenterology, University College London Medical School, London, United Kingdom of Great Britain and Northern Ireland
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Li C, Xie S, Chen D, Zhang J, Zhang N, Mu J, Gong A. Clinicopathological characteristics of early gastric cancer with different level of undifferentiated component and nomogram to predict lymph node metastasis. Front Surg 2023; 10:1097927. [PMID: 36865628 PMCID: PMC9972584 DOI: 10.3389/fsurg.2023.1097927] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Abstract
Background Few studies showed that mixed type early gastric cancer (EGC) relates to higher risk of lymph node metastasis. We aimed to explore the clinicopathological feature of GC according to different proportions of undifferentiated components (PUC) and develop a nomogram to predict status of lymph node metastasis (LNM) in EGC lesions. Methods Clinicopathological data of the 4,375 patients who underwent surgically resection for gastric cancer in our center were retrospectively evaluated and finally 626 cases were included. We classified mixed type lesions into five groups (M1:0% < PUC ≤ 20%, M2:20%<PUC ≤ 40%, M3:40%<PUC ≤ 60%, M4:60%<PUC ≤ 80%, M5:80%<PUC < 100%). Lesions with 0% PUC were classified as pure differentiated group (PD) and lesions with 100% PUC were classified as pure undifferentiated group (PUD). Results Compared with PD, LNM rate was higher in group M4 and group M5 (p < 0.05 after Bonferroni correction). Differences of tumor size, presence of lymphovascular invasion (LVI), perineural invasion and invasion depth also exist between groups. No statistical difference of LNM rate was found in cases who met the absolute endoscopic submucosal dissection (ESD) indications for EGC patients. Multivariate analysis revealed that tumor size over 2 cm, submucosa invasion to SM2, presence of LVI and PUC level M4 significantly predicted LNM in EGC. With the AUC of 0.899(P < 0.05), the nomogram exhibited a good discrimination. Internal validation by Hosmer-Lemeshow test showed a good fitting effect in model (P > 0.05). Conclusion PUC level should be considered as one of the predicting risk factors of LNM in EGC. A nomogram that predicts the risk of LNM in EGC was developed.
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Affiliation(s)
- Chenyu Li
- Department of Gastroenterology, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Suling Xie
- Department of Pathology, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Dan Chen
- Department of Pathology, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Jingwen Zhang
- Department of Gastroenterology, First Affiliated Hospital, Dalian Medical University, Dalian, China,Department of Pathology, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Ning Zhang
- Department of Geriatric Medicine, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Jinchao Mu
- Department of Gastroenterology, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Aixia Gong
- Department of Gastroenterology, First Affiliated Hospital, Dalian Medical University, Dalian, China,Correspondence: Aixia Gong
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5
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Weng CY, Sun SP, Cai C, Xu JL, Lv B. Endoscopic submucosal dissection for early signet ring cell gastric cancer: A systematic review and meta-analysis. World J Clin Cases 2022; 10:6915-6926. [PMID: 36051146 PMCID: PMC9297431 DOI: 10.12998/wjcc.v10.i20.6915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/11/2021] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of endoscopic submucosal dissection (ESD) for treating early signet ring cell carcinoma (SRC) is controversial due to the risk of lymph node metastasis.
AIM To carry out a meta-analysis to evaluate ESD for therapeutic efficacy and safety in early signet ring cell gastric cancer.
METHODS The PubMed, Web of Science, Cochrane Library, and EMBASE databases were used to search for relevant studies evaluating the therapeutic efficacy and safety of ESD in SRC. The rates of recurrence, complete resection, incomplete resection, curative resection, en bloc resection, and adverse events were extracted and analyzed. The methodological quality of the enrolled studies was assessed using the Newcastle-Ottawa Scale. Publication bias was evaluated by the Egger’s test. Institutional review board approval and written consent were not needed for this report.
RESULTS This meta-analysis enrolled seven studies with 653 participants undergoing ESD treatment for early SRC. The overall recurrence rate was 0.010 [95% confidence interval (CI): 0.000-0.040, Z = 1.422, P = 0.155]. The total lymphovascular invasion rate was 0.038 (95%CI: 0.007-0.088, Z = 3.026, P = 0.002). The total en bloc resection rate was estimated at 0.984 (95%CI: 0.925-1.000, Z = 19.463, P = 0.000). The total complete and incomplete resection rates were estimated at 0.785 (95%CI: 0.596-0.928, Z = 9.789, P = 0.000) and 0.188 (95%CI: 0.016-0.468, Z = 2.531, P = 0.011), respectively. The total procedure-associated gastric hemorrhage and perforation rates were estimated at 0.026 (95%CI: 0.005-0.061, Z = 3.006 P = 0.003) and 0.004 (95%CI: 0.000-0.028, Z = 0.938, P = 0.348), respectively. The curative resection, vertical margin invasion, and lateral margin invasion rates were 72.1% (145/341), 2.3% (8/348), and 34.45% (41/119), respectively.
CONCLUSION ESD constitutes a promising therapeutic approach for early undifferentiated SRC gastric cancer. However, further improvements are required for increasing its treatment efficacy and reducing adverse outcomes.
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Affiliation(s)
- Chun-Yan Weng
- Department of Gastroenterology, The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Shao-Peng Sun
- Department of Gastroenterology, The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Chang Cai
- Department of Gastroenterology, The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Jing-Li Xu
- Department of Gastrointestinal Surgery, The First Clinical Medical University of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Bin Lv
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
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Yang S, Gu X, Tao R, Huo J, Hu Z, Sun F, Ni J, Wang X. Relationship between histological mixed-type early gastric cancer and lymph node metastasis: A systematic review and meta-analysis. PLoS One 2022; 17:e0266952. [PMID: 35427370 PMCID: PMC9012370 DOI: 10.1371/journal.pone.0266952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/30/2022] [Indexed: 12/02/2022] Open
Abstract
The clinicopathological features of early gastric cancer (EGC) with mixed-type histology (differentiated and undifferentiated) are incompletely understood, and the capacity of endoscopic submucosal dissection (ESD) to treat mixed-type cancer remains controversial. This systematic review analyzed the rate of lymph node metastasis (LNM) in mixed-type EGC. We gathered articles published up to February 21, 2021, that analyzed the relationship between LNM and mixed-type EGC from Embase, PubMed, and Web of Science. The primary outcome was the LNM rate associated with different histological types of EGC, and the secondary outcomes were the odds ratios (ORs) for LNM risk factors among EGC patients. From the 24 studies included in this meta-analysis, the overall rate of LNM in predominantly differentiated mixed-type (MD) EGC was 12%, whereas the LNM rate in predominantly undifferentiated mixed-type (MU) EGC was 22%. We further divided these studies into 2 groups according to the depth of invasion. In mixed-type mucosal EGC, the pooled LNM rate was 15%; in submucosal EGC, the rate was 33% for MU, which was higher than the rates for pure types (pure differentiated type, 13%; pure undifferentiated type, 21%; p<0.05). The LNM rate of MD was 20%, it was higher than those of the pure differentiated type and nearly the same as pure undifferentiated type. Other pooled statistics showed that submucosal invasion, pure undifferentiated EGC, and mixed-type EGC were independent risk factors for LNM. This meta-analysis showed that MD submucosal EGC has a high rate of LNM and is highly correlated with LNM; thus, the management of MD EGC as purely differentiated EGC according to the indications for ESD is inappropriate, and the mixed type should be added as a parameter in these indications.
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Affiliation(s)
- Shufan Yang
- Nantong University, Nantong City, Jiangsu, P.R. China
| | - Xin Gu
- The Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University, Wuxi City, Jiangsu, P.R. China
| | - Rui Tao
- The Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University, Wuxi City, Jiangsu, P.R. China
| | - Jiahui Huo
- The Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University, Wuxi City, Jiangsu, P.R. China
| | - Zhen Hu
- The Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University, Wuxi City, Jiangsu, P.R. China
| | - Fei Sun
- The Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University, Wuxi City, Jiangsu, P.R. China
| | - Jinbin Ni
- The Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University, Wuxi City, Jiangsu, P.R. China
| | - Xiaoyun Wang
- The Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University, Wuxi City, Jiangsu, P.R. China
- The Affiliated Wuxi Clinical College of Nantong University, Wuxi City, Jiangsu, P.R. China
- * E-mail:
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Inuyama M, Horiuchi Y, Yamamoto N, Yoshimizu S, Ishiyama A, Yoshio T, Hirasawa T, Tsuchida T, Igarashi Y, Fujisaki J. Usefulness of Magnifying Endoscopy with Narrow-Band Imaging for Diagnosing Mixed Poorly Differentiated Gastric Cancers. Digestion 2021; 102:938-945. [PMID: 34515095 DOI: 10.1159/000517970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/20/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Curative rates of endoscopic treatment for undifferentiated-type early gastric cancer (EGC), particularly mixed poorly differentiated adenocarcinoma (MIXED-POR), are lower than those of endoscopic treatment for the differentiated type. Magnifying endoscopy with narrow-band imaging (ME-NBI) is useful for diagnoses of the histological type. This study aimed to investigate the detection rates of MIXED-POR among undifferentiated-type EGCs using biopsy and ME-NBI in order to improve curative rates through endoscopic treatment. METHODS We analyzed 267 lesions initially subjected to endoscopic submucosal resection (ESD) and histologically diagnosed as undifferentiated-type EGCs between July 2005 and December 2016 at our hospital. We obtained written informed consent from all participants. Biopsy and ME-NBI findings were compared to distinguish pure signet ring cell carcinoma (PURE-SIG) and MIXED-POR. ME-NBI findings were divided into 2 categories depending on the presence of irregular vessels. Results of biopsy and ME-NBI (combination method) were also analyzed, and detection rates of MIXED-POR and PURE-SIG were evaluated in terms of sensitivity, specificity, and accuracy. RESULTS Overall, 114 lesions were analyzed. Fifty-eight lesions (50.9%) were identified as MIXED-POR. With biopsy, the detection rate of MIXED-POR was significantly lower than that of PURE-SIG (p < 0.0001). ME-NBI detected significantly more MIXED-POR with irregular vessels than PURE-SIG (p < 0.0001). The combination method could detect significantly more MIXED-POR than PURE-SIG (p < 0.0001). The sensitivity and accuracy for MIXED-POR diagnosis were significantly higher with the combination method than with biopsy alone (p < 0.0001). DISCUSSION/CONCLUSION Combining biopsy and ME-NBI improved the accuracy of pretreatment diagnosis before ESD in undifferentiated-type cancer.
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Affiliation(s)
- Mitsuko Inuyama
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan, .,Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan,
| | - Yusuke Horiuchi
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Noriko Yamamoto
- Department of Pathology, Cancer Institute Hospital, Tokyo, Japan
| | - Shoichi Yoshimizu
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Akiyoshi Ishiyama
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Tomohiro Tsuchida
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Yoshinori Igarashi
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
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8
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Shiotsuki K, Takizawa K, Ono H. Indications of Endoscopic Submucosal Dissection for Undifferentiated Early Gastric Cancer: Current Status and Future Perspectives for Further Expansion. Digestion 2021; 103:76-82. [PMID: 34736250 DOI: 10.1159/000519650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/15/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is a widely accepted and minimally invasive treatment for early gastric cancer (EGC) without the risk of lymph node metastasis (LNM). However, undifferentiated-type EGC (UD-EGC) is considered to have a relatively high risk of LNM. Recently, the Japan Clinical Oncology Group conducted a nonrandomized confirmatory trial (JCOG1009/1010) to evaluate the efficacy and safety of ESD for UD-EGC. Herein, we review the results of JCOG1009/1010 and the possibility of further expanding the indications for ESD. SUMMARY JCOG1009/1010 showed excellent technical results and 5-year overall survival in patients with UD-EGC. Based on the results, ESD for UD-EGC (cT1a) of ≤2 cm without ulceration was technically feasible and acceptable for standard treatment instead of gastrectomy with lymph node dissection. A review of the EGC of mixed histological type (mixed EGC) suggested that the mixed EGC might have worse biological behavior than the pure histological type. In cases of intramucosal EGC with pure signet-ring cell carcinoma or presenting a double-layer structure, the risk of LNM might be relatively low. Thus, there is a possibility of further expanding the indications or curative evaluations. In the case of UD-EGC after noncurative resection, the data suggest that the eCura system may be applicable to UD-EGC; however, due to the small number of cases, further study is warranted. Key Message: This review summarizes the present knowledge regarding indications for UD-EGC and the possibility of further expanding them.
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Affiliation(s)
- Kazuo Shiotsuki
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kohei Takizawa
- Department of Gastroenterology and Endoscopy, Sapporo Kinentou Hospital, Hokkaido, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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Lu H, Sun Y, Zhu Z, Xu H, Huang R, Huang B. Differentiated/undifferentiated mixed type is a prognostic factor for T2/T3 gastric cancer patients. Expert Rev Gastroenterol Hepatol 2021; 15:1329-1336. [PMID: 34431734 DOI: 10.1080/17474124.2021.1973430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This work aimed to find the association of mixed-type histology and prognosis of T2/T3 GC patients. METHODS Eligible T2/T3 gastric cancer patients at our institution were identified. The histological types and risk factors affecting OS were examined. Survival differences were assessed by log-rank tests and Kaplan-Meier curves. RESULTS The study identified 972 T2/T3 gastric cancer patients, including 283 differentiated-type patients, 544 undifferentiated-type patients and 145 mixed type. Mixed-type histology was associated with shorter 5-year OS (DT vs UDT vs MT:57.5% vs 44.9% vs 39.6%, P = 0.002). MT histology can be predictive for prognosis of T2/T3 GC patients (HR for OS: 1.386, 95% CI: 1.028-1.868, P = 0.032), and its malignant potential is not inferior to UDT. In the subgroup analysis, MT can potentially be independent risk factor for non-distal GC patients (P = 0.010). CONCLUSION This study reported that mixed histology could be regarded as a potential prognostic factor for T2/T3 gastric cancer patients, especially for those with non-distal cancer. MT patients have higher incidence of metastasis and recurrence and had poorer prognosis than those with pure histological type. It is necessary for MT patients to have preoperative pathological examination for accurate histologic classification, so as to make the comprehensive treatment strategies..
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Affiliation(s)
- Huiwen Lu
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, Shenyang, PR China
| | - Yimeng Sun
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, Shenyang, PR China
| | - Zirui Zhu
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, Shenyang, PR China
| | - Huimian Xu
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, Shenyang, PR China
| | - Rui Huang
- Department of Clinical Medicine of Year 2017, Dalian Medical University, Dalian, PR China
| | - Baojun Huang
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, Shenyang, PR China
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Ning FL, Zhang NN, Wang J, Jin YF, Quan HG, Pei JP, Zhao Y, Zeng XT, Abe M, Zhang CD. Prognostic value of modified Lauren classification in gastric cancer. World J Gastrointest Oncol 2021; 13:1184-1195. [PMID: 34616522 PMCID: PMC8465445 DOI: 10.4251/wjgo.v13.i9.1184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/01/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It remains controversial as to which pathological classification is most valuable in predicting the overall survival (OS) of patients with gastric cancer (GC).
AIM To assess the prognostic performances of three pathological classifications in GC and develop a novel prognostic nomogram for individually predicting OS.
METHODS Patients were identified from the Surveillance, Epidemiology, and End Results program. Univariate and multivariate analyses were performed to identify the independent prognostic factors. Model discrimination and model fitting were evaluated by receiver operating characteristic curves and Akaike information criteria. Decision curve analysis was performed to assess clinical usefulness. The independent prognostic factors identified by multivariate analysis were further applied to develop a novel prognostic nomogram.
RESULTS A total of 2718 eligible GC patients were identified. The modified Lauren classification was identified as one of the independent prognostic factors for OS. It showed superior model discriminative ability and model-fitting performance over the other pathological classifications, and similar results were obtained in various patient settings. In addition, it showed superior net benefits over the Lauren classification and tumor differentiation grade in predicting 3- and 5-year OS. A novel prognostic nomogram incorporating the modified Lauren classification showed superior model discriminative ability, model-fitting performance, and net benefits over the American Joint Committee on Cancer 8th edition tumor-node-metastasis classification.
CONCLUSION The modified Lauren classification shows superior net benefits over the Lauren classification and tumor differentiation grade in predicting OS. A novel prognostic nomogram incorporating the modified Lauren classification shows good model discriminative ability, model-fitting performance, and net benefits.
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Affiliation(s)
- Fei-Long Ning
- Department of General Surgery, Xuzhou Hospital of Traditional Chinese Medicine, Xuzhou 221000, Jiangsu Province, China
| | - Nan-Nan Zhang
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi’an 710000, Shannxi Province, China
| | - Jun Wang
- Department of General Surgery, Xuzhou Hospital of Traditional Chinese Medicine, Xuzhou 221000, Jiangsu Province, China
| | - Yi-Feng Jin
- Department of General Surgery, Jiading Hospital of Traditional Chinese Medicine, Shanghai 201800, China
| | - Hong-Guang Quan
- Department of General Surgery, Xuzhou Hospital of Traditional Chinese Medicine, Xuzhou 221000, Jiangsu Province, China
| | - Jun-Peng Pei
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, Liaoning Province, China
| | - Yan Zhao
- Department of Stomach Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang 110042, Liaoning Province, China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, The Second Clinical College of Wuhan University, Wuhan 430071, Hubei Province, China
| | - Masanobu Abe
- Division for Health Service Promotion, The University of Tokyo, Tokyo 113-0033, Japan
| | - Chun-Dong Zhang
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, Liaoning Province, China
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
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11
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Dong X, Sun G, Qu H, He Q, Hao Z. Prognostic Significance of Signet-Ring Cell Components in Patients With Gastric Carcinoma of Different Stages. Front Surg 2021; 8:642468. [PMID: 34336913 PMCID: PMC8319562 DOI: 10.3389/fsurg.2021.642468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/14/2021] [Indexed: 01/14/2023] Open
Abstract
Background: Gastric carcinoma (GC), which contains signet ring cell (SRC) components are frequently observed in postoperative pathological assessment. This study aims to study the prognostic significance of SRC components in GC patients. Methods: From 2003 to 2017, surgically resected primary GC patients were retrospectively reviewed. All enrolled patients were divided into three groups according to the proportion of SRC. The overall survival (OS) and disease-free survival (DFS) of GC patients with different tumor stages were analyzed. Results: Patients with SRC or mixed-SRC were more associated with female, younger age, middle or lower third of the stomach, larger tumor, higher pN stage, and more lymphovascular invasion. For GC patients in stage I, multivariate survival analysis showed that age >60, SRC components >50%, and pT stage were independent prognostic factors for OS (all p < 0.05). The 5-year OS of patients with SRC were higher than that of patients with pure adenocarcinoma (p = 0.021). For GC patients in stage II/III, multivariate survival analysis showed that age >60, SRC proportion, surgical types, Borrmann's type, pT stage, pN stage, and lymphovascular invasion were independent prognostic factors for OS (all p < 0.05). The 5-year OS/DFS of patients with SRC were lower than that of patients with pure adenocarcinoma (p < 0.001). Conclusions: SRC seemed to be a favorable prognostic factor in GC patients in stage I. However, for GC patients in stage II/III, the SRC components were associated with poor prognosis, independent of other clinicopathological factors.
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Affiliation(s)
- Xiaoyuan Dong
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
| | - Guorui Sun
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Hui Qu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Qingsi He
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Zhaofan Hao
- Department of Nephrology, Eastern District, Qilu Hospital of Shandong University, Jinan, China
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12
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Zhang QW, Chen JN, Tang ZR, Gao YJ, Ge ZZ, Li XB. Long- and short-term outcomes of early gastric cancer after endoscopic resection: a retrospective study from China. Endosc Int Open 2021; 9:E1086-E1096. [PMID: 34222635 PMCID: PMC8216778 DOI: 10.1055/a-1381-7013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 12/18/2020] [Indexed: 01/16/2023] Open
Abstract
Background and study aims The aim of the study was to evaluate short- and long-term outcomes of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in China because no study has yet been conducted to confirm its effectiveness in EGC in China. Patients and methods A total of 570 EGC samples from 537 patients were collected for evaluation of en bloc, complete, and curative resection using ESD. Data from 302 patients with at least 3 years of active follow-up were collected for analysis of recurrence of EGC and occurrence of metachronous GC (MGC). Short- and long-outcomes of mixed-type and pure differentiated EGC were also compared. Results En bloc resection rates of 96.0 %, 98.7 %, and 95.2 %, complete resection rates of 91.2 %, 96.6 % and 90.8 %, and curative resection rates of 83.0 %, 96.2 % and 88.2 % were achieved in all EGCs included in the study, those with absolute indication, and those with expanded indication, respectively. As a long-term outcome, recurrence was observed in 1.3 % of patients, 3-year and 5-year recurrence rates being 0.7 % and 1.2 %, respectively. Thirteen patients (4.3 %) exhibited MGCs during follow-up, all of which were resected in a second ESD. Conclusions The effectiveness of ESD for EGC in China was confirmed, with satisfactory short- and long-term outcomes. With scheduled follow-up, the outcomes for mixed-type EGC can be similar to those for pure differentiated EGC after complete resection without development of lymphovascular invasion.
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Affiliation(s)
- Qing-Wei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Jin-Nan Chen
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Zhao-Rong Tang
- Department of Gastroenterology and Hepatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Yun-Jie Gao
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Zhi-Zheng Ge
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Xiao-Bo Li
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
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13
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Okagawa Y, Sumiyoshi T, Kondo H, Tomita Y, Uozumi T, Iida R, Sakano H, Tokuchi K, Jin T, Yoshida M, Sakurada A, Fujii R, Minagawa T, Morita K, Yane K, Ihara H, Hirayama M, Oyamada Y, Okushiba S. Comparison of clinicopathological features and long-term prognosis between mixed predominantly differentiated-type and pure differentiated-type early gastric cancer. BMC Cancer 2021; 21:235. [PMID: 33676442 PMCID: PMC7937263 DOI: 10.1186/s12885-021-07962-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/24/2021] [Indexed: 01/04/2023] Open
Abstract
Background Recent studies have shown that mixed predominantly differentiated-type (MD) early gastric cancer (EGC) might have more malignant potential than pure differentiated-type (PD) EGC. However, no study has analyzed all differentiated-type EGC cases treated endoscopically and surgically. This study aimed to compare the differences in clinicopathological features and long-term prognosis between MD- and PD-EGC. Methods We evaluated all patients with differentiated-type EGCs who were treated endoscopically and surgically in our hospital between January 2010 and October 2014. The clinicopathological features and long-term prognosis of MD-EGC were compared with those of PD-EGC. Results A total of 459 patients with 459 lesions were evaluated in this study; of them, 409 (89.1%) and 50 (10.9%) were classified into the PD and MD groups, respectively. Submucosal invasion was found in 96 (23.5%) patients of the PD group and in 33 (66.0%) patients of the MD group (p < 0.01). The rates of positive lymphatic and vascular invasion and ulceration were significantly higher in the MD group than in the PD group (p < 0.01). The proportion of patients with lymph node metastasis was also significantly higher in the MD group than in the PD group (5 (10%) vs 6 (1.5%), p < 0.01). The 5-year overall and EGC-specific survival rates in the PD group were 88.3 and 99.5%, respectively, while they were 94.0 and 98.0% in the MD group, respectively. Conclusions MD-EGC has more malignant potential than PD-EGC. However, the long-term prognosis of MD-EGC is good and is not significantly different from that of PD-EGC when treated appropriately.
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Affiliation(s)
- Yutaka Okagawa
- Department of Gastroenterology, Tonan Hospital, North 4, West 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan.
| | - Tetsuya Sumiyoshi
- Department of Gastroenterology, Tonan Hospital, North 4, West 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
| | - Hitoshi Kondo
- Department of Gastroenterology, Tonan Hospital, North 4, West 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
| | - Yusuke Tomita
- Department of Gastroenterology, Tonan Hospital, North 4, West 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
| | - Takeshi Uozumi
- Department of Gastroenterology, Tonan Hospital, North 4, West 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
| | - Reiichi Iida
- Department of Gastroenterology, Tonan Hospital, North 4, West 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
| | - Hiroya Sakano
- Department of Gastroenterology, Tonan Hospital, North 4, West 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
| | - Kaho Tokuchi
- Department of Gastroenterology, Tonan Hospital, North 4, West 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
| | - Takashi Jin
- Department of Gastroenterology, Tonan Hospital, North 4, West 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
| | - Masahiro Yoshida
- Department of Gastroenterology, Tonan Hospital, North 4, West 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
| | - Akira Sakurada
- Department of Gastroenterology, Tonan Hospital, North 4, West 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
| | - Ryoji Fujii
- Department of Gastroenterology, Tonan Hospital, North 4, West 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
| | - Takeyoshi Minagawa
- Department of Gastroenterology, Tonan Hospital, North 4, West 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
| | - Kohtaro Morita
- Department of Gastroenterology, Tonan Hospital, North 4, West 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
| | - Kei Yane
- Department of Gastroenterology, Tonan Hospital, North 4, West 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
| | - Hideyuki Ihara
- Department of Gastroenterology, Tonan Hospital, North 4, West 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
| | - Michiaki Hirayama
- Department of Gastroenterology, Tonan Hospital, North 4, West 7, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
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Ishioka M, Yoshio T, Miyamoto Y, Namikawa K, Tokai Y, Yoshimizu S, Horiuchi Y, Ishiyama A, Hirasawa T, Tsuchida T, Fujisaki J. Incidence of metachronous cancer after endoscopic submucosal dissection: a comparison between undifferentiated-type and differentiated-type early gastric cancer. Gastrointest Endosc 2021; 93:557-564.e1. [PMID: 32621817 DOI: 10.1016/j.gie.2020.06.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/26/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) has become an important and minimally invasive treatment for early gastric cancer (EGC) with a negligible risk of metastasis not only for differentiated-type (D-type) cancer but also for undifferentiated-type (UD-type) cancer. We aimed to investigate the incidence and characteristics of metachronous cancer after ESD for UD-type cancer, which has not yet been elucidated. METHODS In total, 175 patients who underwent ESD for UD-type EGC were enrolled. For comparison, 350 patients who underwent ESD for D-type EGC during the same period were randomly selected. These patients underwent a follow-up EGD annually. The median observation period was 6.0 years and 5.4 years, respectively. RESULTS The annual incidence of metachronous cancer after ESD for UD-type and D-type cancer was .9% and 5.3%, respectively. Among the patients who underwent ESD for UD-type cancer, 30.9% of patients were uninfected with Helicobacter pylori, whereas all patients who underwent ESD for D-type cancer were infected with H pylori. All patients who developed metachronous cancer were infected with H pylori. UD-type metachronous cancer developed more frequently in patients after ESD for UD-type cancer than after ESD for D-type cancer, and the curative resection rate of ESD was significantly lower in these cases. CONCLUSIONS Metachronous cancers developed only in H pylori-infected patients in this cohort. Although metachronous cancer incidence was significantly less frequent in patients after ESD for UD-type cancer, the curative resection rate of ESD was significantly lower. Routine surveillance should be conducted more carefully after ESD for UD-type cancer, especially in H pylori-infected patients.
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Affiliation(s)
- Mitsuaki Ishioka
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yuji Miyamoto
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ken Namikawa
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshitaka Tokai
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shoichi Yoshimizu
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yusuke Horiuchi
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiyoshi Ishiyama
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Tsuchida
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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Horiuchi Y, Hirasawa T, Ishizuka N, Tokai Y, Namikawa K, Yoshimizu S, Ishiyama A, Yoshio T, Tsuchida T, Fujisaki J, Tada T. Performance of a computer-aided diagnosis system in diagnosing early gastric cancer using magnifying endoscopy videos with narrow-band imaging (with videos). Gastrointest Endosc 2020; 92:856-865.e1. [PMID: 32422155 DOI: 10.1016/j.gie.2020.04.079] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/24/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS The performance of magnifying endoscopy with narrow-band imaging (ME-NBI) using a computer-aided diagnosis (CAD) system in diagnosing early gastric cancer (EGC) is unclear. Here, we aimed to clarify the differences in the diagnostic performance between expert endoscopists and the CAD system using ME-NBI. METHODS The CAD system was pretrained using 1492 cancerous and 1078 noncancerous images obtained using ME-NBI. One hundred seventy-four videos (87 cancerous and 87 noncancerous videos) were used to evaluate the diagnostic performance of the CAD system using the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). For each item, comparisons were made between the CAD system and 11 experts who were skilled in diagnosing EGC using ME-NBI with clinical experience of more than 1 year at our hospital. RESULTS The CAD system demonstrated an AUC of 0.8684. The accuracy, sensitivity, specificity, PPV, and NPV were 85.1% (95% confidence interval [95% CI], 79.0-89.6), 87.4% (95% CI, 78.8-92.8), 82.8% (95% CI, 73.5-89.3), 83.5% (95% CI, 74.6-89.7), and 86.7% (95% CI, 77.8-92.4), respectively. The CAD system was significantly more accurate than 2 experts, significantly less accurate than 1 expert, and not significantly different from the remaining 8 experts. CONCLUSIONS The overall performance of the CAD system using ME-NBI videos in diagnosing EGC was considered good and was equivalent to or better than that of several experts. The CAD system may prove useful in the diagnosis of EGC in clinical practice.
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Affiliation(s)
- Yusuke Horiuchi
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Naoki Ishizuka
- Department of Clinical Trial Planning and Management, Cancer Institute Hospital, Tokyo, Japan
| | - Yoshitaka Tokai
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Ken Namikawa
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Shoichi Yoshimizu
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Akiyoshi Ishiyama
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Tomohiro Tsuchida
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Tomohiro Tada
- AI Medical Service Inc., Tokyo, Japan; Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan
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Tang X, Zhang M, He Q, Sun G, Wang C, Gao P, Qu H. Histological Differentiated/Undifferentiated Mixed Type Should Not Be Considered as a Non-Curative Factor of Endoscopic Resection for Patients With Early Gastric Cancer. Front Oncol 2020; 10:1743. [PMID: 33014861 PMCID: PMC7494733 DOI: 10.3389/fonc.2020.01743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022] Open
Abstract
Background Histological differentiated/undifferentiated mixed-type adenocarcinomas are frequently found in patients with early gastric cancer (EGC). Yet it is unclear whether these mixed-type adenocarcinomas can be treated by endoscopic resection (ER) in EGC patients. Aims To evaluate the lymph node metastasis (LNM) rate and long-term outcomes in mixed-type EGC patients and assess the feasibility of ER in these patients. Methods Clinicopathological features, risk factors of LNM, and overall survival (OS) and progression-free survival (PFS) rates of EGC patients were analyzed according to different histological types. Results Patients with mixed-type EGC had higher LNM rates than patients with non-mixed-type EGC (11.4 vs. 6.2%, P = 0.044). In the multivariate analysis, larger tumor diameter, presence of an ulcer, submucosal invasion, histological undifferentiated type, histological mixed type, and lymphovascular invasion resulted as independent risk factors for LNM in EGC patients (all P < 0.05). The LNM rate in mixed-type patients who met the Japanese ER criteria was 3.3%, including fulfilling the absolute criteria 0%. The 5-year OS and PFS rates in mixed-type patients were 94.59 and 91.47%, respectively. There was no statistical significance in the OS (P = 0.870) and PFS (P = 0.705) between mixed-type and non-mixed-type EGC patients fulfilling the Japanese ER criteria. Conclusion Histological differentiated/undifferentiated mixed type in EGC patients meeting the Japanese absolute criteria for ER are associated with low risk of LNM and favorable prognosis, and thus, it should not be considered as a non-curative factor for ER.
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Affiliation(s)
- Xiaolong Tang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Mengjun Zhang
- Department of General Surgery, Lanling People's Hospital, Linyi, China
| | - Qingsi He
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Guorui Sun
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Chao Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Peng Gao
- Department of Pathology, Qilu Hospital of Shandong University, Jinan, China
| | - Hui Qu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
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17
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De Marco MO, Tustumi F, Brunaldi VO, Resende RH, Matsubayashi CO, Baba ER, Chaves DM, Bernardo WM, de Moura EGH. Prognostic factors for ESD of early gastric cancers: a systematic review and meta-analysis. Endosc Int Open 2020; 8:E1144-E1155. [PMID: 32904802 PMCID: PMC7458740 DOI: 10.1055/a-1201-3089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/12/2020] [Indexed: 02/06/2023] Open
Abstract
Background and study aims Gastric neoplasms are one of the leading types of cancer in the world and early detection is essential to improve prognosis. Endoscopy is the gold-standard diagnostic procedure and allows adequate treatment in selected cases. Endoscopic submucosal dissection (ESD) has been reported to safely address most early gastric cancers (EGCs), with high curability rates. However, data on prognostic factors related to ESDs of EGCs are conflicting. Therefore, we aimed to systematically review the available literature and to perform a meta-analysis to identify the relevant prognostic factors in this context. Methods We performed this study according to PRISMA guidelines. Comparative studies assessing the relationship between curative resection or long-term curability rates and relevant prognostic factors were selected. Prognostic factors were demographic data, lesion features (location, morphology of the lesion, size, and depth of invasion), histological findings, Helycobacter pylori (HP) infection, presence of gastric a atrophy and body mass index (BMI). Finally, we also evaluated risk factors related to metachronous gastric neoplasm. Results The initial search retrieved 2829 records among which 46 studies were included for systematic review and meta-analysis. The total sample comprised 28366 patients and 29282 lesions. Regarding curative resection, pooled data showed no significant influence of sex [odds ratio (OR): 1.15 (0,97, 1.36) P = 0.10 I 2 = 47 %] , age [OR: 1.00 (0.61, 1.64) P = 1.00 I 2 = 58 %], posterior vs non-posterior location [OR: 1.35 (0.81, 2.27) P = 0.25 I 2 = 84 %], depressed vs von-depressed macroscopic type[OR: 1.21 (0.99, 1.49) P = 0.07 I 2 = 0 %], non-upper vs upper location [OR: 1.41 (0.93, 2.14) P = 0.10 I 2 = 77 %] and BMI [OR: 0.84 (0.57; 1.26) P = 0.41 I 2 = 0 %]. Differentiated neoplasms presented greater chance of cure compare to undifferentiated [OR: 0.10 (0.07, 0.15) P < 0.00001 I 2 = 0 %]. Ulcerated lesions had lower curative rates compared to non-ulcerated [OR: 3.92 (2.81, 5.47) P < 0.00001 I 2 = 44 %]. Lesions smaller than 20 mm had greater chance of curative resection [OR: 3.94 (3.25, 4.78) P < 0.00001 I 2 = 38 %]. Bleeding during procedure had lower curative rates compared to non-bleeding [OR: 2.13 (1.56, 2.93) P < 0.0001 I 2 = 0 %]. Concerning long-term cure, female gender [OR 1.62 (1.33, 1.97) P < 0.00001 I 2 = 0 %] and the mucosal over SM1 cancers were protective factors [OR: 0.08 (0.02, 0.39) P = 0.002 I 2 = 86 %]. Gastric atrophy [OR: 0.60 (0.45, 0.81) P = 0.0006 I 2 = 42 %] and the pepsinogen I/pepsinogen II ratio [OR 2.29 (1.47, 3.57) P = 0.0002 I 2 = 0 %] were risk factors to metachronous gastric neoplasm. Conclusions Ulcerated lesions, histology, bleeding and size > 20 mm are prognostic factors concerning curative resection. Regarding long-term cure, female gender and mucosal over SM1 cancer are predictive factors. Gastric atrophy and the pepsinogen ratio are risk factors for metachronous gastric neoplasm.
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Affiliation(s)
- Michele Oliveira De Marco
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Francisco Tustumi
- Department of Gastroenterology, Digestive Surgery Division, Sao Paulo School of Medicine
| | - Vitor Ottoboni Brunaldi
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil; Center for Gastrointestinal Endoscopy, Surgery and Anatomy Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ricardo Hannum Resende
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Carolina Ogawa Matsubayashi
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Elisa Ryoka Baba
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Dalton Marques Chaves
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
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Zou Y, Wu L, Yang Y, Shen X, Zhu C. Risk factors of tumor invasion and node metastasis in early gastric cancer with undifferentiated component: a multicenter retrospective study on biopsy specimens and clinical data. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:360. [PMID: 32355804 PMCID: PMC7186605 DOI: 10.21037/atm.2020.02.42] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Early gastric cancer (EGC) with undifferentiated component (UDC) is a more aggressive entity, where the significance of preoperative data to tumor invasion and lymph node metastasis (LNM) remains unclarified. Methods A total of 5,020 GC patients undergoing radical gastrectomy in three centers were reviewed, of which, EGC with UDC in preoperative biopsy specimens were enrolled. The histology of biopsy and surgical specimens was graded according to the proportion of UDC and signet ring cells (SRCs). Risk factors of tumor invasion and LNM were evaluated with histological, clinical and demographic data. Results Lower body mass index (BMI), melena and larger tumor size were the independent preoperative risk factors of both LNM and LVI, while ulcerative lesion (UL) and the lower third stomach were only correlated with LNM. No relevance was found between the histological features of biopsy specimens and LNM, but SRC or >50% UDC lowered the risk of lymphovascular invasion (LVI) and/or submucosal (SM) invasion. When surgical data (depth of invasion and LVI included) were added, lower BMI, melena and the lower third stomach were still the independent preoperative risk factors of LNM, and LVI, SRC and SM invasion also showed relevance to LNM. The performance of predictive models using pre- or postoperative histological data was comparable. Conclusions The preoperative data were significantly relevant to tumor invasion and LNM, showing comparable risk strength with surgical specimens in histology.
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Affiliation(s)
- Yi Zou
- Department of Pathology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Long Wu
- Department of Pathology, Union Hospital of Fujian Medical University, Fuzhou 350001, China
| | - Yubin Yang
- Department of Pathology, Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China
| | - Xin Shen
- College of Computer Science and Technology, Zhejiang University, Hangzhou 310027, China
| | - Chunpeng Zhu
- Department of Gastroenterology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
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Gastric endoscopic submucosal dissection: a systematic review and meta-analysis on risk factors for poor short-term outcomes. Eur J Gastroenterol Hepatol 2019; 31:1234-1246. [PMID: 31498283 DOI: 10.1097/meg.0000000000001542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Endoscopic submucosal dissection (ESD) is now established as the first option to manage early gastric neoplasms, but its efficacy may vary according to diverse factors. We aimed to systematically identify risk factors for poor short-term outcomes of gastric ESD with the purpose to improve patients' selection and management. METHODS Three online databases (MEDLINE, ISI Web of Knowledge and Scopus) were searched (last search on June 2018) for poor outcomes of gastric ESD (deep submucosal invasion, piecemeal/incomplete resection, noncurative resection and local recurrence). RESULTS One hundred five studies were included referring to 52.126 ESDs. Undifferentiated histology and upper location (vs lower) were associated with submucosal invasion [odds ratio (OR) = 2.42 [95% confidence interval (CI), 1.62-3.61] and OR = 3.20 (1.04-9.86), respectively] and deep submucosal invasion [OR = 2.98 (2.02-4.39) and OR = 2.35 (1.45-3.81), respectively]. Lesion size greater than 30 mm and ulceration were associated with piecemeal resection [OR = 2.78 (1.17-6.60) and OR = 2.76 (1.23, 6.20), respectively]. Lesion size greater than 30 mm, ulceration, upper location and fibrosis were risk factors for incomplete resection [OR = 3.83 (2.68-5.49), OR = 4.06 (1.62-10.16), OR = 3.71 (2.49-5.54) and OR = 4.46 (1.66-11.96), respectively]. A noncurative resection was more often observed for lesions located in the upper third of the stomach [OR = 1.49 (1.24-1.79)], depressed morphology [OR = 1.49 (1.04-2.12)] and those outside standard criteria [OR = 3.56 (2.31-5.48)]. Older age was significantly linked with local recurrence rates [OR = 3.08 (1.13-5.02)]. CONCLUSION Several risk factors influence poor efficacy short-term outcomes of gastric ESD that may be used to inform both patients and health providers about the expected efficacy.
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Abstract
An organ-specific chronic inflammation–remodeling–carcinoma sequence has been proposed, mainly for the alimentary tract. As representative diseases, gastroesophageal reflux disease, chronic gastritis and inflammatory bowel disease (ulcerative colitis and Crohn’s disease of the colitis type) were adopted for this discussion. Tissue remodeling is such an important part of tumorigenesis in this sequence that an organ-specific chronic inflammation–remodeling–carcinoma sequence has been proposed in detail. Chronic inflammation accelerates the cycle of tissue injury and regeneration; in other words, cell necrosis (or apoptosis) and proliferation result in tissue remodeling in long-standing cases of inflammation. Remodeling encompasses epithelial cell metaplasia and stromal fibrosis, and modifies epithelial–stromal cell interactions. Further, the accumulation of genetic, epigenetic and molecular changes—as well as morphologic disorganization—also occurs during tissue remodeling. The expression of mucosal tissue adapted to chronic inflammatory injury is thought to occur at an early stage. Subsequently, dysplasia and carcinoma develop on a background of remodeling due to continuous, active inflammation. Accordingly, organ-specific chronic inflammation should be ameliorated or well controlled with appropriate monitoring if complete healing is unachievable.
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Bang CS, Baik GH. Pitfalls in the Interpretation of Publications about Endoscopic Submucosal Dissection of Early Gastric Cancer with Undifferentiated-Type Histology. Clin Endosc 2019; 52:30-35. [PMID: 30650945 PMCID: PMC6370935 DOI: 10.5946/ce.2018.158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 11/02/2018] [Indexed: 12/14/2022] Open
Abstract
Endoscopic submucosal dissection (ESD) is a standard treatment for patients with gastrointestinal neoplasms with a negligible risk of lymph node metastasis. ESD enables en bloc resection of gastrointestinal neoplasms and organ preservation, thereby, avoiding surgical treatment. Although small (<2 cm) intramucosal early gastric cancer with undifferentiated-type histology (EGC-UH) without ulceration is included in the expanded criteria for ESD, controversies remain due to different biology and characteristics compared to EGC with differentiated-type histology. The authors previously presented studies about the technical feasibility of ESD for these lesions using a meta-analysis and retrospective multicenter analysis. However, many pitfalls were identified in the interpretation of studies analyzing histologic discrepancy, mixed-type histology, criteria-based analysis of therapeutic outcomes, interpretation of curative resection, and long-term clinical outcomes. In this review, the authors discuss pitfalls in the interpretation of publications on ESD for EGC-UH.
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Affiliation(s)
- Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
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Bang CS, Choi JH, Yang YJ, Lee JJ, Baik GH. Endoscopic submucosal dissection of early gastric cancer with mixed-type histology: Protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13838. [PMID: 30572552 PMCID: PMC6320129 DOI: 10.1097/md.0000000000013838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/04/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is a primary treatment for the early gastric cancer (EGC) who have a negligible risk of lymph node metastasis satisfying specific criteria. These criteria are histologically categorized by EGC with differentiated-type histology (EGC-DH) and undifferentiated-type histology (EGC-UH). However, gastric cancer is histologically heterogenous and there has been no specific criteria for EGC with mixed-type histology (EGC-MH). Moreover, therapeutic outcomes of ESD for EGC-MH have not been clearly described. METHODS We will search the core databases (MEDLINE (through PubMed), the Cochrane Library, and Embase) from their inception to November 2018 using pre-established searching strategy by 2 independent evaluators. The P.I.C.O. is as follows; Patients: who have EGC-MH, Intervention: ESD, Comparison: none, Outcome: at least one among the rate of complete resection, curative resection, en bloc resection, recurrence or procedure-related adverse event that enabled an evaluation of feasibility of ESD. All types of study design will be sought and publications in English with full-text will be included. The risk of bias will be assessed using the ROBINS-I tool. Descriptive data synthesis is planned and quantitative synthesis will be used if the included studies are sufficiently homogenous (pooled therapeutic outcomes data with 95% confidence intervals). Publication bias will be assessed with quantitative analyses if more than 10 articles are enrolled. RESULTS The results will provide evidence for validity of current ESD criteria in addition to the technical feasibility of ESD for EGC-MH. CONCLUSION This study will provide evidence of ESD for EGC-MH.
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Affiliation(s)
- Chang Seok Bang
- Department of Internal Medicine
- Institute of New Frontier Research
| | | | - Young Joo Yang
- Department of Internal Medicine
- Institute of New Frontier Research
| | - Jae Jun Lee
- Institute of New Frontier Research
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Chuncheon, Korea
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