Protocol for expanded indications of endoscopic submucosal dissection for early gastric cancer in China: a multicenter, ambispective, observational, open-cohort study

Gastric Cancer in Gorj County - a Clinical-Statistical Study

Gastric cancer (GC) is the fourth most common cause of cancer death worldwide, with about 769,000 deaths/year worldwide. Recent studies showed a continuous decrease in the incidence and mortality of gastric cancer mainly in developed countries, while the incidence remains increased in some countries in Eastern Asia and Eastern Europe. For the assessment of some parameters of gastric cancer in Gorj county, all the medical records of patients diagnosed with gastric cancer, found in the Archive of the County Emergency Hospital of Tg Jiu, were analyzed, namely the admission records within the Surgery and Oncology departments, the observation sheets of every individual patient, the biological test reports, the histopathological records of the patients with gastric cancer undergoing surgery, the histopathological records of gastric biopsies, the medical imaging records (ultrasound, x-ray, computer tomography and magnetic resonance). The analysis of the medical records showed that the disease mainly affects men, the ratio of men/women being 2/1-3/1. Most cases undergoing surgery within the County Hospital of Tg. Jiu were diagnosed in stages III or IV. The most numerous cases (over 85% of the total group of patients) were identified in people over 61 years old. The most common histopathological form of cancer was adenocarcinoma (95% of all gastric tumors).

Construction and analysis of an ulcer risk prediction model after endoscopic submucosal dissection for early gastric cancer

BACKGROUND

Endoscopic submucosal dissection (ESD) has been widely used in the treatment of early gastric cancer (EGC). A personalized and effective prediction method for ESD with EGC is urgently needed.

AIM

To construct a risk prediction model for ulcers after ESD for EGC based on LASSO regression.

METHODS

A total of 196 patients with EGC who received ESD treatment were prospectively selected as the research subjects and followed up for one month. They were divided into an ulcer group and a non-ulcer group according to whether ulcers occurred. The general data, pathology, and endoscopic characteristics of the groups were compared, and the best risk predictor subsets were screened by LASSO regression and tenfold cross-validation. Multivariate logistic regression was applied to analyze the risk factors for ulcers after ESD in patients with EGC. A receiver operating characteristic (ROC) curve was used to estimate the predictive model performance.

RESULTS

One month after the operation, no patient was lost to follow-up. The incidence of ulcers was 20.41% (40/196) (ulcer group), and the incidence of no ulcers was 79.59% (156/196) (non-ulcer group). There were statistically significant differences in the course of disease, Helicobacter pylori infection history, smoking history, tumor number, clopidogrel medication history, lesion diameter, infiltration depth, convergent folds, and mucosal discoloration between the groups. Gray's medication history, lesion diameter, convergent folds, and mucosal discoloration, which were the 4 nonzero regression coefficients, were screened by LASSO regression analysis. Further multivariate logistic analysis showed that lesion diameter [Odds ratios (OR) = 30.490, 95%CI: 8.584-108.294], convergent folds (OR = 3.860, 95%CI: 1.060-14.055), mucosal discoloration (OR = 3.191, 95%CI: 1.016-10.021), and history of clopidogrel (OR = 3.554, 95%CI: 1.009-12.515) were independent risk factors for ulcers after ESD in patients with EGC (P < 0.05). The ROC curve showed that the area under the curve of the risk prediction model for ulcers after ESD in patients with EGC was 0.944 (95%CI: 0.902-0.972).

CONCLUSION

Clopidogrel medication history, lesion diameter, convergent folds, and mucosal discoloration can predict the occurrence of ulcers after ESD in patients with EGC.

Current indications for endoscopic submucosal dissection of early gastric cancer

The development of endoscopic treatment technology has further promoted the minimally invasive treatment of early gastric cancer (EGC). Endoscopic treatment has achieved better therapeutic effects in terms of safety and prognosis and is the preferred treatment method for patients who meet the indications for endoscopic treatment. However, the consequent problem is that some patients receiving endoscopic treatment may undergo non-curative resection, and the principle of follow-up management for non-curative resection patients deserves further attention. In addition, there are still debates on how to improve the accuracy of clinical staging, select a reasonable treatment method for patients who meet the expanded indications for endoscopic treatment, manage patients with positive endoscopic surgical margins, conduct research on function-preserving surgery, and manage the treatment of EGC under the current situation in China. Consequently, we aim to review current indications for endoscopic submucosal dissection of EGC in order to better inform treatment options.