1
|
Uno K, Shimura T, Inaguma S, Kuroyanagi K, Nishigaki R, Kanno T, Sasaki M, Fukusada S, Sugimura N, Mizuno Y, Nukui T, Kojima Y, Tanaka M, Ozeki K, Kubota E, Takahashi S, Kataoka H. Clinical Impact of Proton Pump Inhibitor and Potassium-Competitive Acid Blocker for Predicting the Curability of Endoscopic Resection in Ulcerative Early Gastric Cancer. Digestion 2024; 105:192-200. [PMID: 38310859 DOI: 10.1159/000536617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/01/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Endoscopic diagnosis is essential for predicting the curability of early gastric cancer (EGC; R0 resection) before treatment, but the relationship between ulcerative lesions and clinical outcomes remains unclear. We aimed to investigate the effect of proton pump inhibitor (PPI) or potassium-competitive acid blocker (P-CAB) on the morphological changes of ulcerative EGCs and its relevance to the clinical outcomes. METHODS Altogether, 143 patients with differentiated ulcerative EGC that were resected by endoscopic submucosal dissection were retrospectively identified and divided into the following two cohorts depending on their PPI/P-CAB administration status: PPI/P-CAB (n = 76) and non-PPI/P-CAB (n = 67) cohorts. Furthermore, in each cohort, the patients were further divided into the improved and unimproved subgroups based on the ulcerative changes. RESULTS In the PPI/P-CAB cohort, the deep submucosal invasion and lymphovascular invasion rates were significantly higher in the unimproved subgroup than in the improved subgroup, resulting in a significantly lower R0 resection rate. Contrarily, no significant differences were found between the two subgroups in the non-PPI/P-CAB cohort. The significance of PPI/P-CAB administration was observed only in the ulcerative EGCs with open-type atrophy (R0 resection rate; improved vs. unimproved, 90.9% vs. 48.0%, p = 0.001). When the finding of improved ulcer with PPI/P-CAB administration was used as the indication of endoscopic resection in ulcerative EGCs with open-type atrophy, high sensitivity (78.9%) and accuracy (76.3%) rates for the curability were observed, which were higher than those of conventional endoscopic diagnosis alone (p = 0.021). CONCLUSION PPI or P-CAB administration might contribute to the potential selection of ulcerative EGCs, enabling endoscopic curative resection.
Collapse
Affiliation(s)
- Konomu Uno
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takaya Shimura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shingo Inaguma
- Department of Experimental Pathology and Tumor Biology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Pathology, Nagoya City University East Medical Center, Nagoya, Japan
| | - Keita Kuroyanagi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ruriko Nishigaki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takuya Kanno
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Makiko Sasaki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shigeki Fukusada
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Naomi Sugimura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yusuke Mizuno
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takayuki Nukui
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuki Kojima
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mamoru Tanaka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Keiji Ozeki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Eiji Kubota
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoru Takahashi
- Department of Experimental Pathology and Tumor Biology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| |
Collapse
|
2
|
Song JH, Lee S, Park SH, Kottikias A, Abdulmohsen A, Alrashidi N, Cho M, Kim YM, Kim HI, Hyung WJ. Applicability of endoscopic submucosal dissection for patients with early gastric cancer beyond the expanded indication for endoscopic submucosal dissection. Surg Endosc 2022; 36:8349-8357. [PMID: 35546209 DOI: 10.1007/s00464-022-09288-6] [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: 10/12/2021] [Accepted: 04/18/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) application for patients with tumors beyond the expanded indication for ESD is inconclusive. This study aimed to identify the preoperative clinical features that can be curatively treated with ESD in patients with early gastric cancer (EGC) beyond the indication of ESD. METHODS From 2006 to 2016, 673 patients who underwent gastrectomy for EGC beyond the expanded indication for ESD based on preoperative assessments were retrospectively reviewed. We identified tumors curatively resected by ESD based on the postoperative pathologic findings. We also analyzed the clinical and pre-treatment features to determine the risk factors associated with curative resection of ESD. RESULTS 39% of the patients (263/673) who had undergone gastrectomy had tumors of endoscopic curability A or B (eCuraA/B) that could be treated by ESD alone. In multivariate analysis, tumor size ≤ 10 mm (OR 0.240; 95% CI = 0.12-0.46), no ulceration (OR 0.500; 95% CI = 0.29-0.87), differentiated histology (OR 0.599; 95% CI = 0.43-0.84), and location in the distal two-thirds of the stomach (OR 0.499; 95% CI = 0.28-0.88) in pre-treatment assessment were identified as independent predictors of eCuraA/B. Considering the risk factors, 63.6% (7/11)/61.3% (19/31) of patients with a differentiated/undifferentiated tumor size ≤ 10 mm located in distal two-third of the stomach without ulceration were deemed as eCuraA/B. CONCLUSIONS This study suggests that patients with EGC indicated for surgery can be treated by ESD by adding tumor locations in the indication for ESD. Thus, ESD can be applied for patients with a tumor size ≤ 10 mm located in the lower/middle stomach without ulceration.
Collapse
Affiliation(s)
- Jeong Ho Song
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Sejin Lee
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Sung Hyun Park
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Anastasios Kottikias
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Aleisa Abdulmohsen
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
- King Fahad Hospital, Saudi Ministry of Health, Jidda, Saudi Arabia
| | - Nasser Alrashidi
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
- Department of Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Buraydah, Al-Qassim, Saudi Arabia
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea.
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.
| |
Collapse
|
3
|
Xie C, Chen Z, Xu J, Meng Z, Huang Z, Lin J. Influence of Lymphangio vascular (V) and perineural (N) invasion on survival of patients with resected esophageal squamous cell carcinoma (ESCC): a single-center retrospective study. PeerJ 2022; 10:e12974. [PMID: 35256918 PMCID: PMC8898008 DOI: 10.7717/peerj.12974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/31/2022] [Indexed: 01/11/2023] Open
Abstract
Background Lymphangio vascular invasion (LVI) and perineural invasion (PNI) are associated with survival following resection for gastrointestinal cancer. But the relationship between LVI/PNI and survival of esophageal squamous cell carcinoma (ESCC) is still unclear. We aim to demonstrate the prognostic significance of LVI/PNI in ESCC. Methods A total of 195 ESCC patients underwent curative surgery from 2012 to 2018 was collected in the 2nd Affiliated Hospital of Fujian Medical University. All the patients were divided into four groups based on the status of the neurovascular invasion: (1) neither LVI nor PNI (V0N0); (2) LVI alone (V1N0); (3) PNI alone (V0N1); (4) combined LVI and PNI (V1N1). First, the analysis included the Kaplan-Meier survival estimates with the Log rank test were performed to determine median overall survival (OS) in different groups divided according to the clinical factor, respectively. And the association between OS with multi clinical factors was examined using Cox regression analysis. Next, the risk factors for recurrence in patients with V1N1 were analyzed with univariate and multivariate logistic regression analyses, respectively. Results The cases in V0N0, V1N0, V0N1, and V1N1 groups were 91 (46.7%), 62 (31.8%), 9 (4.6%) and 33 (16.9%), respectively. The OS in the four groups was different (P < 0.001). The 1-, 3- and 5-year OS in V0N0 group was higher than that in V1N1 group, respectively (1-year OS: 93.4% vs 75.8%, 3-year OS: 53.8 % vs 24.2%, 5-year OS: 48.1% vs 10.5%). The OS in stage I-II for patients with V1N1 was significantly lower than that in the other groups (V0N0, V1N0, V0N1) (P < 0.001). The postoperative adjuvant chemotherapy was a significant impact factor of OS for ESCC patients with V1N1 (P = 0.004). Lymphatic invasion and LVI were significantly prognosis factors associated (P = 0.036, P = 0.030, respectively). The ulcerative type is a risk factor for V1N1 occurance (P = 0.040). Conclusions The LVI and PNI are important prognosis factors for ESCC patients. ESCC patients with simultaneous lymphangio vascular and perineural invasion (V1N1) showed worse OS than patients with either lymphangio vascular or perineural invasion alone (V1N0 or V0N1) or none (V0N0). In addition, adjuvant chemotherapy may prolong the OS for ESCC patients with V1N1.
Collapse
Affiliation(s)
- Chengke Xie
- Department of Gastrointestinal & Esophageal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Zhiyao Chen
- Department of Gastrointestinal & Esophageal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Jie Xu
- Department of Gastrointestinal & Esophageal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Zhiyong Meng
- Department of Ophthalmology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Zhijun Huang
- Department of Gastrointestinal & Esophageal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Jianqing Lin
- Department of Thyroid & Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| |
Collapse
|
4
|
Wang J, Shan F, Li S, Li Z, Wu Q. Effect of administration of a proton pump inhibitor for ulcerative differentiated early gastric cancer prior to endoscopic submucosal dissection. Dig Endosc 2021; 33:939-947. [PMID: 33184984 DOI: 10.1111/den.13892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Predicting the depth of invasion for early gastric cancer (EGC) with ulcerative findings may prove difficult. The purpose of this study was to evaluate the extent of ulcer healing and clinical effectiveness of proton pump inhibitor (PPI) administration for ulcerative differentiated EGC prior to endoscopic submucosal dissection (ESD). METHODS A total of 214 patients with ulcerative differentiated EGC who were treated by ESD were retrospectively analyzed, among whom 129 had been administered a PPI prior to ESD and 85 patients had not. The degree of ulcer healing following administration of PPI and the clinical outcome were compared between the PPI and non-PPI groups. RESULTS The ulcer healing rate (80.7 vs. 30.6%, P < 0.001) and complete ulcer healing rate (45.0 vs. 16.5%, P < 0.001) differed significantly between the PPI and non-PPI groups, respectively. The ESD procedure time was 86.0 (73) vs. 100.0 (68.0) min (P = 0.044). However, no significant differences were observed in the en bloc resection rate, complete resection rate, or the incidence of adverse events. Based on the multivariate regression analysis, PPI administration [odds ratio (OR) = 4.909, 95% confidence interval (CI) 2.459-9.799, P < 0.001] and mucosal cancer (OR = 9.336, 95% CI 2.693-32.362, P < 0.001) were independent predictive factors for complete ulcer healing. Partial or complete ulcer healing following PPI administration had a better predictive ability than EUS for mucosal invasion (kappa value 0.553 vs. 0.101; Youden index 0.553 vs. 0.132). CONCLUSIONS Partial or complete ulcer healing following PPI administration predicts differentiated EGC that is confined to the mucosa.
Collapse
Affiliation(s)
- Jing Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Fei Shan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Shijie Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Ziyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Qi Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China
| |
Collapse
|
5
|
Ren MH, Qi XS, Chu YN, Yu YN, Chen YQ, Zhang P, Mao T, Tian ZB. Risk of Lymph Node Metastasis and Feasibility of Endoscopic Treatment in Ulcerative Early Gastric Cancer. Ann Surg Oncol 2021; 28:2407-2417. [PMID: 32975685 PMCID: PMC7940277 DOI: 10.1245/s10434-020-09153-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND When the risk of lymph node metastasis (LNM) is considered minimal in patients with early gastric cancer (EGC), endoscopic submucosal dissection (ESD) is an effective alternative to radical resection. This study aims to estimate the feasibility of ESD for EGC with ulceration. PATIENTS AND METHODS We retrospectively reviewed data from 691 patients who underwent gastrectomy for EGC with ulceration. Subsequently, a stratification system for lesions was created based on the expanded ESD criteria, and the associations between the subgroups and the rate of LNM were analyzed. RESULTS LNM was confirmed in 16.5% (114/691) of patients. Univariate analysis demonstrated that age, sex, tumor size, macroscopic features, depth of invasion, tumor differentiation, Lauren type, lymphovascular invasion (LVI), and perineural invasion were associated with LNM. Multivariate analysis showed that LVI [odds ratio (OR) = 16.761, P < 0.001], SM1 invasion (OR = 2.159, P = 0.028), and SM2 invasion (OR = 3.230, P < 0.001) were independent risk factors for LNM. LNM occurred in undifferentiated mucosal tumors, with ulceration being 1.7% (2/116) when the lesion was smaller than 20 mm. Further stratification revealed that among lesions < 30 mm in size, undifferentiated tumors with SM1 invasion had a higher rate of LNM and a lower disease-free survival rate than differentiated tumors with SM1 invasion and tumors limited to the mucosal layer. CONCLUSIONS Depth of invasion and LVI were strongly associated with LNM in ulcerative EGC. Endoscopic resection may be applicable for undifferentiated mucosal ulcerative EGC < 30 mm in size, and additional investigation is needed to evaluate its safety.
Collapse
Affiliation(s)
- Ming-Han Ren
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xing-Si Qi
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yu-Ning Chu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ya-Nan Yu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yun-Qing Chen
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Peng Zhang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Tao Mao
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zi-Bin Tian
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| |
Collapse
|
6
|
Fernández-Esparrach G, Marín-Gabriel JC, Díez Redondo P, Núñez H, Rodríguez de Santiago E, Rosón P, Calvet X, Cuatrecasas M, Cubiella J, Moreira L, Pardo López ML, Pérez Aisa Á, Sanz Anquela JM. Quality in diagnostic upper gastrointestinal endoscopy for the detection and surveillance of gastric cancer precursor lesions: Position paper of AEG, SEED and SEAP. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 44:448-464. [PMID: 33609597 DOI: 10.1016/j.gastrohep.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/31/2020] [Accepted: 01/14/2021] [Indexed: 02/07/2023]
Abstract
This position paper, sponsored by the Asociación Española de Gastroenterología [Spanish Association of Gastroenterology], the Sociedad Española de Endoscopia Digestiva [Spanish Gastrointestinal Endoscopy Society] and the Sociedad Española de Anatomía Patológica [Spanish Anatomical Pathology Society], aims to establish recommendations for performing an high quality upper gastrointestinal endoscopy for the screening of gastric cancer precursor lesions (GCPL) in low-incidence populations, such as the Spanish population. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates different measures to improve the quality of upper gastrointestinal endoscopy in this setting and makes recommendations on how to evaluate and treat the identified lesions. We recommend that upper gastrointestinal endoscopy for surveillance of GCPL should be performed by endoscopists with adequate training, administering oral premedication and use of sedation. To improve the identification of GCPL, we recommend the use of high definition endoscopes and conventional or digital chromoendoscopy and, for biopsies, NBI should be used to target the most suspicious areas of intestinal metaplasia. Regarding the evaluation of visible lesions, the risk of submucosal invasion should be evaluated with magnifying endoscopes and endoscopic ultrasound should be reserved for those with suspected deep invasion. In lesions amenable to endoscopic resection, submucosal endoscopic dissection is considered the technique of choice.
Collapse
Affiliation(s)
- Glòria Fernández-Esparrach
- Departamento de Gastroenterología, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España.
| | - José Carlos Marín-Gabriel
- Servicio de Medicina de Aparato Digestivo, Consulta de Alto Riesgo de Neoplasias Gastrointestinales, Unidad de Endoscopias, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Instituto de Investigación «i+12», Madrid, España
| | - Pilar Díez Redondo
- Servicio de Gastroenterología, Unidad de Endoscopias, Consulta de Alto Riesgo de Neoplasias Digestivas, Hospital Universitario Río Hortega, Valladolid, España
| | - Henar Núñez
- Servicio de Gastroenterología, Unidad de Endoscopias, Consulta de Alto Riesgo de Neoplasias Digestivas, Hospital Universitario Río Hortega, Valladolid, España
| | - Enrique Rodríguez de Santiago
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Ramon y Cajal, Universidad de Alcalá, IRYCIS, Madrid, España
| | - Pedro Rosón
- Servicio de Aparato Digestivo, Hospital Quirón, Málaga, España
| | - Xavier Calvet
- Servei d'Aparell Digestiu, Hospital Universitari Parc Taulí, Departament de Medicina, Universitat Autònoma de Barcelona. CIBERehd, Instituto de Salud CarlosIII, Sabadell, Barcelona, España
| | - Miriam Cuatrecasas
- Servicio de Anatomía Patológica, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España
| | - Joaquín Cubiella
- Servicio de Aparato Digestivo, Hospital Universitario de Ourense, Instituto de Investigación Sanitaria Galicia Sur, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Ourense, España
| | - Leticia Moreira
- Departamento de Gastroenterología, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España
| | - M Luisa Pardo López
- Servicio de Patología, Hospital Virgen del Mirón, Complejo Hospitalario de Soria, Soria, España
| | - Ángeles Pérez Aisa
- Unidad de Aparato Digestivo, Agencia Sanitaria Costa del Sol, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Marbella, Málaga, España
| | - José Miguel Sanz Anquela
- Servicio de Anatomía Patológica, Hospital Universitario Príncipe de Asturias, Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, España
| | | |
Collapse
|
7
|
Kim Y. What is the Most Precise Endoscopic Finding for Predicting the Clinicopathological Behaviors in Ulcerative Early Gastric Cancer? Clin Endosc 2020; 53:249-250. [PMID: 32506890 PMCID: PMC7280837 DOI: 10.5946/ce.2020.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/18/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Youngdae Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| |
Collapse
|
8
|
Kawai S, Fujii T, Shimizu T, Sukegawa K, Hashimoto I, Okumura T, Nagata T, Sakai H, Fujii T. Pathophysiological properties of CLIC3 chloride channel in human gastric cancer cells. J Physiol Sci 2020; 70:15. [PMID: 32066374 PMCID: PMC7026216 DOI: 10.1186/s12576-020-00740-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 02/04/2020] [Indexed: 11/24/2022]
Abstract
Pathophysiological functions of chloride intracellular channel protein 3 (CLIC3) in human gastric cancer have been unclear. In the tissue microarray analysis using 107 gastric cancer specimens, CLIC3 expression was negatively correlated with pathological tumor depth, and the patients with lower expression of CLIC3 exhibited poorer prognosis. CLIC3 was expressed in the plasma membrane of cancer cells in the tissue. CLIC3 expression was also found in a human gastric cancer cell line (MKN7). In whole-cell patch-clamp recordings of the cells expressing CLIC3, NPPB-sensitive outwardly rectifying Cl− currents were observed. Cell proliferation was significantly accelerated by knockdown of CLIC3 in MKN7 cells. On the other hand, the proliferation was attenuated by exogenous CLIC3 expression in human gastric cancer cells (KATOIII and NUGC-4) in which endogenous CLIC3 expression is negligible. Our results suggest that CLIC3 functions as a Cl− channel in the plasma membrane of gastric cancer cells and that decreased expression of CLIC3 results in unfavorable prognosis of gastric cancer patients.
Collapse
Affiliation(s)
- Shunsuke Kawai
- Department of Surgery and Sciences, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, 930-0194, Japan
| | - Takuto Fujii
- Department of Pharmaceutical Physiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Takahiro Shimizu
- Department of Pharmaceutical Physiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Kenta Sukegawa
- Department of Surgery and Sciences, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, 930-0194, Japan
| | - Isaya Hashimoto
- Department of Surgery and Sciences, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, 930-0194, Japan
| | - Tomoyuki Okumura
- Department of Surgery and Sciences, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, 930-0194, Japan
| | - Takuya Nagata
- Department of Surgery and Sciences, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, 930-0194, Japan
| | - Hideki Sakai
- Department of Pharmaceutical Physiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Tsutomu Fujii
- Department of Surgery and Sciences, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, 930-0194, Japan
| |
Collapse
|
9
|
Lee J, Kim BW, Huh CW, Kim JS, Maeng LS. Endoscopic Factors that Can Predict Histological Ulcerations in Early Gastric Cancers. Clin Endosc 2020; 53:328-333. [PMID: 31906605 PMCID: PMC7280847 DOI: 10.5946/ce.2019.133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/04/2019] [Indexed: 12/11/2022] Open
Abstract
Background/Aims Predicting histological ulceration in early gastric cancer (EGC) during endoscopic examination is crucial for endoscopists deciding on the treatment modality. The aim of this study was to investigate the endoscopic factors that can predict histological ulcerations in EGCs.
Methods We retrospectively analyzed patients who underwent endoscopic submucosal dissection (ESD) for EGC. Clinical features and endoscopic characteristics of EGC such as location, histological differentiation, longest diameter, tumor morphology, mucosal break, converging fold, color change, and surface irregularity were reviewed. Histological ulceration was defined based on ESD specimens.
Results A total of 633 EGC lesions from 613 patients were included and histological ulcerations were found in 90 lesions (14.2%). Presence of converging folds, tumor morphology, and color changes on endoscopic examination were related to histological ulceration in the univariate analysis and converging folds along with color changes were statistically significant factors in the multivariate analysis. Kaplan–Meier analysis showed that patients with histological ulcerations in EGCs tended to have higher marginal recurrence rates.
Conclusions Mucosal breaks are not equivalent to histological ulcerations. Rather, the existence of converging folds and color changes during endoscopic examination suggest histological ulcerations. Endoscopists should consider these factors when they decide the treatment modality for EGCs.
Collapse
Affiliation(s)
- Jaesin Lee
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Byung-Wook Kim
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Cheal Wung Huh
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Joon Sung Kim
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Lee-So Maeng
- Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| |
Collapse
|
10
|
Kim TY, Yi NH, Hwang JW, Kim JH, Kim GH, Kang MS. Morphologic pattern analysis of submucosal deformities identified by endoscopic ultrasonography for predicting the depth of invasion in early gastric cancer. Surg Endosc 2018; 33:2169-2180. [PMID: 30334157 DOI: 10.1007/s00464-018-6496-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aims of this study are to evaluate the usefulness of submucosal deformity pattern analysis with endoscopic ultrasonography (EUS) for predicting the depth of invasion in early gastric cancer (EGC) and the treatment results of endoscopic submucosal dissection (ESD). METHODS The endoscopic and EUS parameters of 345 patients with endoscopically suspected EGC who underwent endoscopic or surgical resection between July 2012 and May 2017 were retrospectively reviewed. All patients were classified into three categories as follows according to the morphologic type of submucosal deformity identified by EUS: (1) no submucosal deformity, (2) wedge-shaped deformity, and (3) arch-shaped deformity. The presence of an arch-shaped submucosal deformity on EUS and an active endoscopic ulcer or surrounding mucosal fold convergence/clubbing on conventional endoscopy were defined as suggestive of deep submucosal cancer invasion (SCI). RESULTS Upper location (p = 0.034) and the presence of an arch-shaped submucosal deformity on EUS (p < 0.001) were significant predictors of deep submucosal invasion, with the presence of an arch-shaped submucosal deformity showing the highest predictive value (odds ratio of 26.27). The overall diagnostic accuracy of EUS for predicting deep SCI was 83.5%, with a sensitivity of 84.0% and a specificity of 83.3%, which were significantly higher than those of conventional endoscopy. A larger lesion size and the presence of an arch-shaped submucosal deformity were significant factors associated with noncurative resection after ESD. CONCLUSIONS Submucosal deformity pattern analysis with EUS can provide more accurate information than conventional endoscopy for predicting deep SCI. The presence of an arch-shaped submucosal deformity on EUS was an effective predictor of deep SCI and noncurative resection.
Collapse
Affiliation(s)
- Tae Young Kim
- Department of Gastroenterology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokjiro, Busanjin-Gu, Busan, 47392, South Korea
| | - Nam Hee Yi
- Department of Gastroenterology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokjiro, Busanjin-Gu, Busan, 47392, South Korea
| | - Jin Won Hwang
- Department of Gastroenterology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokjiro, Busanjin-Gu, Busan, 47392, South Korea
| | - Ji Hyun Kim
- Department of Gastroenterology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokjiro, Busanjin-Gu, Busan, 47392, South Korea.
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, South Korea
| | - Mi Seon Kang
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| |
Collapse
|
11
|
Myung YS, Hong SJ, Han JP, Park KW, Ko BM, Lee MS. Effects of administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer. Gastric Cancer 2017; 20:200-206. [PMID: 26661593 DOI: 10.1007/s10120-015-0578-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/13/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND In ulcerative early gastric cancer, improvement and exacerbation of ulceration repeat as a malignant cycle. Moreover, early gastric cancer combined with ulcer is associated with a low curative resection rate and high risk of adverse events. The aim of this study was to investigate the ulcer healing rate and clinical outcomes with the administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer. METHODS A total of 136 patients with differentiated early gastric cancer with ulcer who met the expanded indications for endoscopic submucosal dissection were reviewed between June 2005 and June 2014. Eighty-one patients were given PPI before endoscopic submucosal dissection and 55 patients were not given PPI. RESULTS The complete ulcer healing rate was significantly different between the two groups (59.3 % vs. 23.6 %, P < 0.001). The procedure time was 38.1 ± 35.7 and 50.8 ± 50.2 min (P = 0.047). However, no significant differences were detected in the en bloc resection rate, complete resection rate, and adverse events including bleeding and perforation. Multivariate analysis showed that administration of PPI (OR = 10.83, P < 0.001) and mucosal invasion (OR = 24.43, P < 0.001) were independent factors that predicted complete healing of ulceration. The calculated accuracy for whether complete healing of the ulcer after PPI administration can differentiate mucosal from submucosal invasion was 75.3 %. CONCLUSIONS Administration of PPI before ESD in differentiated EGC meeting the expanded criteria is effective to heal the ulcer lesion and reduce the mean procedure time. Complete healing of the ulcer after PPI administration suggests mucosal cancer.
Collapse
Affiliation(s)
- Yu Sik Myung
- Department of Internal Medicine, Digestive Disease Center, Soon Chun Hyang University School of Medicine, Soon Chun Hyang University Bucheon Hospital, 1174 Jung-Dong, Wonmi-Ku, Bucheon, 420-767, Korea
| | - Su Jin Hong
- Department of Internal Medicine, Digestive Disease Center, Soon Chun Hyang University School of Medicine, Soon Chun Hyang University Bucheon Hospital, 1174 Jung-Dong, Wonmi-Ku, Bucheon, 420-767, Korea.
| | - Jae Pil Han
- Department of Internal Medicine, Digestive Disease Center, Soon Chun Hyang University School of Medicine, Soon Chun Hyang University Bucheon Hospital, 1174 Jung-Dong, Wonmi-Ku, Bucheon, 420-767, Korea
| | - Kyung Woo Park
- Department of Internal Medicine, Digestive Disease Center, Soon Chun Hyang University School of Medicine, Soon Chun Hyang University Bucheon Hospital, 1174 Jung-Dong, Wonmi-Ku, Bucheon, 420-767, Korea
| | - Bong Min Ko
- Department of Internal Medicine, Digestive Disease Center, Soon Chun Hyang University School of Medicine, Soon Chun Hyang University Bucheon Hospital, 1174 Jung-Dong, Wonmi-Ku, Bucheon, 420-767, Korea
| | - Moon Sung Lee
- Department of Internal Medicine, Digestive Disease Center, Soon Chun Hyang University School of Medicine, Soon Chun Hyang University Bucheon Hospital, 1174 Jung-Dong, Wonmi-Ku, Bucheon, 420-767, Korea
| |
Collapse
|
12
|
Lee YJ, Kim JH, Park JJ, Youn YH, Park H, Kim JW, Choi SH, Noh SH. The Implications of Endoscopic Ulcer in Early Gastric Cancer: Can We Predict Clinical Behaviors from Endoscopy? PLoS One 2016; 11:e0164339. [PMID: 27741275 PMCID: PMC5065238 DOI: 10.1371/journal.pone.0164339] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/24/2016] [Indexed: 01/15/2023] Open
Abstract
Background The presence of ulcer in early gastric cancer (EGC) is important for the feasibility of endoscopic resection, only a few studies have examined the clinicopathological implications of endoscopic ulcer in EGC. Objectives To determine the role of endoscopic ulcer as a predictor of clinical behaviors in EGC. Methods Data of 3,270 patients with EGC who underwent surgery between January 2005 and December 2012 were reviewed. Clinicopathological characteristics were analyzed in relation to the presence and stage of ulcer in EGC. Based on endoscopic findings, the stage of ulcer was categorized as active, healing, or scar. Logistic regression analysis was performed to analyze factors associated with lymph node metastasis (LNM). Results 2,343 (71.7%) patients had endoscopic findings of ulceration in EGC. Submucosal (SM) invasion, LNM, lymphovascular invasion (LVI), perineural invasion, and undifferentiated-type histology were significantly higher in ulcerative than non-ulcerative EGC. Comparison across different stages of ulcer revealed that SM invasion, LNM, and LVI were significantly associated with the active stage, and that these features exhibited significant stage-based differences, being most common at the active stage, and least common at the scar stage. The presence of endoscopic ulcer and active status of the ulcer were identified as independent risk factors for LNM. Conclusions Ulcerative EGC detected by endoscopy exhibited more aggressive behaviors than non-ulcerative EGC. Additionally, the endoscopic stage of ulcer may predict the clinicopathological behaviors of EGC. Therefore, the appearance of ulcers should be carefully evaluated to determine an adequate treatment strategy for EGC.
Collapse
Affiliation(s)
- Yoo Jin Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jie-Hyun Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
| | - Jae Jun Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Hoon Youn
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyojin Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Won Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Ho Choi
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
13
|
Park JS, Kim H, Bang B, Kwon K, Shin Y. Accuracy of endoscopic ultrasonography for diagnosing ulcerative early gastric cancers. Medicine (Baltimore) 2016; 95:e3955. [PMID: 27472672 PMCID: PMC5265809 DOI: 10.1097/md.0000000000003955] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Although endoscopic ultrasonography (EUS) is the first-choice imaging modality for predicting the invasion depth of early gastric cancer (EGC), the prediction accuracy of EUS is significantly decreased when EGC is combined with ulceration.The aim of present study was to compare the accuracy of EUS and conventional endoscopy (CE) for determining the depth of EGC. In addition, the various clinic-pathologic factors affecting the diagnostic accuracy of EUS, with a particular focus on endoscopic ulcer shapes, were evaluated.We retrospectively reviewed data from 236 consecutive patients with ulcerative EGC. All patients underwent EUS for estimating tumor invasion depth, followed by either curative surgery or endoscopic treatment. The diagnostic accuracy of EUS and CE was evaluated by comparing the final histologic result of resected specimen. The correlation between accuracy of EUS and characteristics of EGC (tumor size, histology, location in stomach, tumor invasion depth, and endoscopic ulcer shapes) was analyzed. Endoscopic ulcer shapes were classified into 3 groups: definite ulcer, superficial ulcer, and ill-defined ulcer.The overall accuracy of EUS and CE for predicting the invasion depth in ulcerative EGC was 68.6% and 55.5%, respectively. Of the 236 patients, 36 patients were classified as definite ulcers, 98 were superficial ulcers, and 102 were ill-defined ulcers, In univariate analysis, EUS accuracy was associated with invasion depth (P = 0.023), tumor size (P = 0.034), and endoscopic ulcer shapes (P = 0.001). In multivariate analysis, there is a significant association between superficial ulcer in CE and EUS accuracy (odds ratio: 2.977; 95% confidence interval: 1.255-7.064; P = 0.013).The accuracy of EUS for determining tumor invasion depth in ulcerative EGC was superior to that of CE. In addition, ulcer shape was an important factor that affected EUS accuracy.
Collapse
Affiliation(s)
| | - Hyungkil Kim
- Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea
- Correspondence: Hyungkil Kim, Department of Internal Medicine, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon 400-711, Republic of Korea (e-mail: )
| | | | | | | |
Collapse
|