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Characteristics of metachronous gastric neoplasms after curative endoscopic submucosal dissection for early gastric neoplasms
With the wide application of endoscopic submucosal dissection (ESD) for early gastric neoplasms, metachronous gastric neoplasms (MGN) have gradually become a concern. This study aimed to analyze the characteristics of MGN and evaluate the treatment and follow-up outcomes of MGN patients. A total of...
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Published in: | Chinese medical journal 2021-10, Vol.134 (21), p.2603-2610 |
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description | With the wide application of endoscopic submucosal dissection (ESD) for early gastric neoplasms, metachronous gastric neoplasms (MGN) have gradually become a concern. This study aimed to analyze the characteristics of MGN and evaluate the treatment and follow-up outcomes of MGN patients.
A total of 814 patients were retrospectively enrolled. All these patients were treated by ESD for early gastric cancer or gastric dysplasia between November 2006 and September 2019 at The First Medical Center of Chinese People's Liberation Army General Hospital. The risk factors for MGN were analyzed using Cox hazard proportional model. Moreover, the cumulative incidence, the correlation of initial lesions and MGN lesions, and the treatment and follow-up outcomes of MGN patients were analyzed.
A total of 4.5% (37/814) of patients had MGN after curative ESD. The 3-, 5-, and 7-year cumulative incidences of MGN were 3.5%, 5.1%, and 6.9%, respectively, and ultimately reaching a plateau of 11.3% at 99 months after ESD. There was no significant correlation between initial lesions and MGN lesions in terms of gross type (P = 0.178), location (long axis: P = 0.470; short axis: P = 0.125), and histological type (P = 0.832). Cox multivariable analysis found that initial multiplicity was the only independent risk factor of MGN (hazard ratio: 4.3, 95% confidence interval: 2.0-9.4, P < 0.001). Seventy-three percent of patients with MGN were treated by endoscopic resection. During follow-up, two patients with MGN died of gastric cancer with lymph node metastasis. The disease-specific survival rate was significantly lower in patients with MGN than that in patients without MGN (94.6% vs. 99.6%, P = 0.006).
The MGN rate gradually increased with follow-up time within 99 months after curative gastric ESD. Thus, regular and long-term surveillance endoscopy may be helpful, especially for patients with initial multiple neoplasms. |
doi_str_mv | 10.1097/CM9.0000000000001762 |
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A total of 814 patients were retrospectively enrolled. All these patients were treated by ESD for early gastric cancer or gastric dysplasia between November 2006 and September 2019 at The First Medical Center of Chinese People's Liberation Army General Hospital. The risk factors for MGN were analyzed using Cox hazard proportional model. Moreover, the cumulative incidence, the correlation of initial lesions and MGN lesions, and the treatment and follow-up outcomes of MGN patients were analyzed.
A total of 4.5% (37/814) of patients had MGN after curative ESD. The 3-, 5-, and 7-year cumulative incidences of MGN were 3.5%, 5.1%, and 6.9%, respectively, and ultimately reaching a plateau of 11.3% at 99 months after ESD. There was no significant correlation between initial lesions and MGN lesions in terms of gross type (P = 0.178), location (long axis: P = 0.470; short axis: P = 0.125), and histological type (P = 0.832). Cox multivariable analysis found that initial multiplicity was the only independent risk factor of MGN (hazard ratio: 4.3, 95% confidence interval: 2.0-9.4, P < 0.001). Seventy-three percent of patients with MGN were treated by endoscopic resection. During follow-up, two patients with MGN died of gastric cancer with lymph node metastasis. The disease-specific survival rate was significantly lower in patients with MGN than that in patients without MGN (94.6% vs. 99.6%, P = 0.006).
The MGN rate gradually increased with follow-up time within 99 months after curative gastric ESD. Thus, regular and long-term surveillance endoscopy may be helpful, especially for patients with initial multiple neoplasms.</description><identifier>ISSN: 0366-6999</identifier><identifier>EISSN: 2542-5641</identifier><identifier>DOI: 10.1097/CM9.0000000000001762</identifier><identifier>PMID: 34608068</identifier><language>eng</language><publisher>China: Lippincott Williams & Wilkins</publisher><subject>Atrophy ; Biopsy ; Cancer therapies ; Endoscopic Mucosal Resection ; Endoscopy ; Gastric cancer ; Gastric Mucosa - surgery ; Gastrointestinal surgery ; Histology ; Humans ; Infections ; Lymphatic system ; Metastasis ; Neoplasms, Second Primary - surgery ; Original ; Patients ; Retrospective Studies ; Stomach Neoplasms - surgery ; Treatment Outcome ; Tumors</subject><ispartof>Chinese medical journal, 2021-10, Vol.134 (21), p.2603-2610</ispartof><rights>Lippincott Williams & Wilkins</rights><rights>Copyright © 2021 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.</rights><rights>Copyright © 2021 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0 (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright © 2021 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5476-6a4ba1b38742b05814e1da0c8dc0386505102105384e6ed79bfa194c11e48e583</citedby><cites>FETCH-LOGICAL-c5476-6a4ba1b38742b05814e1da0c8dc0386505102105384e6ed79bfa194c11e48e583</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8577659/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2594802331?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34608068$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Xu, Shan-Shan</creatorcontrib><creatorcontrib>Chai, Ning-Li</creatorcontrib><creatorcontrib>Tang, Xiao-Wei</creatorcontrib><creatorcontrib>Linghu, En-Qiang</creatorcontrib><creatorcontrib>Wang, Sha-Sha</creatorcontrib><creatorcontrib>Li, Bao</creatorcontrib><title>Characteristics of metachronous gastric neoplasms after curative endoscopic submucosal dissection for early gastric neoplasms</title><title>Chinese medical journal</title><addtitle>Chin Med J (Engl)</addtitle><description>With the wide application of endoscopic submucosal dissection (ESD) for early gastric neoplasms, metachronous gastric neoplasms (MGN) have gradually become a concern. This study aimed to analyze the characteristics of MGN and evaluate the treatment and follow-up outcomes of MGN patients.
A total of 814 patients were retrospectively enrolled. All these patients were treated by ESD for early gastric cancer or gastric dysplasia between November 2006 and September 2019 at The First Medical Center of Chinese People's Liberation Army General Hospital. The risk factors for MGN were analyzed using Cox hazard proportional model. Moreover, the cumulative incidence, the correlation of initial lesions and MGN lesions, and the treatment and follow-up outcomes of MGN patients were analyzed.
A total of 4.5% (37/814) of patients had MGN after curative ESD. The 3-, 5-, and 7-year cumulative incidences of MGN were 3.5%, 5.1%, and 6.9%, respectively, and ultimately reaching a plateau of 11.3% at 99 months after ESD. There was no significant correlation between initial lesions and MGN lesions in terms of gross type (P = 0.178), location (long axis: P = 0.470; short axis: P = 0.125), and histological type (P = 0.832). Cox multivariable analysis found that initial multiplicity was the only independent risk factor of MGN (hazard ratio: 4.3, 95% confidence interval: 2.0-9.4, P < 0.001). Seventy-three percent of patients with MGN were treated by endoscopic resection. During follow-up, two patients with MGN died of gastric cancer with lymph node metastasis. The disease-specific survival rate was significantly lower in patients with MGN than that in patients without MGN (94.6% vs. 99.6%, P = 0.006).
The MGN rate gradually increased with follow-up time within 99 months after curative gastric ESD. Thus, regular and long-term surveillance endoscopy may be helpful, especially for patients with initial multiple neoplasms.</description><subject>Atrophy</subject><subject>Biopsy</subject><subject>Cancer therapies</subject><subject>Endoscopic Mucosal Resection</subject><subject>Endoscopy</subject><subject>Gastric cancer</subject><subject>Gastric Mucosa - surgery</subject><subject>Gastrointestinal surgery</subject><subject>Histology</subject><subject>Humans</subject><subject>Infections</subject><subject>Lymphatic system</subject><subject>Metastasis</subject><subject>Neoplasms, Second Primary - surgery</subject><subject>Original</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Stomach Neoplasms - surgery</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><issn>0366-6999</issn><issn>2542-5641</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNplkktv1DAUhSMEokPhHyAUiQ2bFL9jb5DQiEelIjawtm6cm4kHTzzYSasu-O94mFLa4o0l-_iTz7mnql5SckaJad-uv5gzcmfRVrFH1YpJwRqpBH1crQhXqlHGmJPqWc5bQpiUrXpanXChiCZKr6pf6xESuBmTz7N3uY5DvcMZ3JjiFJdcbyDPybt6wrgPkHe5hqGoa7ckmP0l1jj1Mbu4L5q8dLvFxQyh7n3O6GYfp3qIqUZI4fp_1vPqyQAh44ub_bT6_vHDt_Xn5uLrp_P1-4vGSdEWCyA6oB3XrWAdkZoKpD0Qp3tHuFaSSEoYJZJrgQr71nQDUCMcpSg0Ss1Pq_Mjt4-wtfvkd5CubQRv_xzEtLGQiv2AtuQiKQ6aaQDBleiUMx3IDjhDMbihsN4dWfviFnuH05wg3IPev5n8aDfx0mrZtkqaAnhzA0jx54J5tjufHYYAJZclWyZbw1tTJlWkrx9It3FJU4mqqIzQhHFOi0ocVS7FnBMOt5-hxB66YktX7MOulGev7hq5ffS3HP-4VzGUkecfYbnCZEeEMI8HHjOck4aV7GlJnzQHsuK_AftKzFU</recordid><startdate>20211004</startdate><enddate>20211004</enddate><creator>Xu, Shan-Shan</creator><creator>Chai, Ning-Li</creator><creator>Tang, Xiao-Wei</creator><creator>Linghu, En-Qiang</creator><creator>Wang, Sha-Sha</creator><creator>Li, Bao</creator><general>Lippincott Williams & Wilkins</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><general>Wolters Kluwer</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20211004</creationdate><title>Characteristics of metachronous gastric neoplasms after curative endoscopic submucosal dissection for early gastric neoplasms</title><author>Xu, Shan-Shan ; Chai, Ning-Li ; Tang, Xiao-Wei ; Linghu, En-Qiang ; Wang, Sha-Sha ; Li, Bao</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5476-6a4ba1b38742b05814e1da0c8dc0386505102105384e6ed79bfa194c11e48e583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Atrophy</topic><topic>Biopsy</topic><topic>Cancer therapies</topic><topic>Endoscopic Mucosal Resection</topic><topic>Endoscopy</topic><topic>Gastric cancer</topic><topic>Gastric Mucosa - surgery</topic><topic>Gastrointestinal surgery</topic><topic>Histology</topic><topic>Humans</topic><topic>Infections</topic><topic>Lymphatic system</topic><topic>Metastasis</topic><topic>Neoplasms, Second Primary - surgery</topic><topic>Original</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Stomach Neoplasms - surgery</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Xu, Shan-Shan</creatorcontrib><creatorcontrib>Chai, Ning-Li</creatorcontrib><creatorcontrib>Tang, Xiao-Wei</creatorcontrib><creatorcontrib>Linghu, En-Qiang</creatorcontrib><creatorcontrib>Wang, Sha-Sha</creatorcontrib><creatorcontrib>Li, Bao</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest Publicly Available Content database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>Chinese medical journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Xu, Shan-Shan</au><au>Chai, Ning-Li</au><au>Tang, Xiao-Wei</au><au>Linghu, En-Qiang</au><au>Wang, Sha-Sha</au><au>Li, Bao</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characteristics of metachronous gastric neoplasms after curative endoscopic submucosal dissection for early gastric neoplasms</atitle><jtitle>Chinese medical journal</jtitle><addtitle>Chin Med J (Engl)</addtitle><date>2021-10-04</date><risdate>2021</risdate><volume>134</volume><issue>21</issue><spage>2603</spage><epage>2610</epage><pages>2603-2610</pages><issn>0366-6999</issn><eissn>2542-5641</eissn><abstract>With the wide application of endoscopic submucosal dissection (ESD) for early gastric neoplasms, metachronous gastric neoplasms (MGN) have gradually become a concern. This study aimed to analyze the characteristics of MGN and evaluate the treatment and follow-up outcomes of MGN patients.
A total of 814 patients were retrospectively enrolled. All these patients were treated by ESD for early gastric cancer or gastric dysplasia between November 2006 and September 2019 at The First Medical Center of Chinese People's Liberation Army General Hospital. The risk factors for MGN were analyzed using Cox hazard proportional model. Moreover, the cumulative incidence, the correlation of initial lesions and MGN lesions, and the treatment and follow-up outcomes of MGN patients were analyzed.
A total of 4.5% (37/814) of patients had MGN after curative ESD. The 3-, 5-, and 7-year cumulative incidences of MGN were 3.5%, 5.1%, and 6.9%, respectively, and ultimately reaching a plateau of 11.3% at 99 months after ESD. There was no significant correlation between initial lesions and MGN lesions in terms of gross type (P = 0.178), location (long axis: P = 0.470; short axis: P = 0.125), and histological type (P = 0.832). Cox multivariable analysis found that initial multiplicity was the only independent risk factor of MGN (hazard ratio: 4.3, 95% confidence interval: 2.0-9.4, P < 0.001). Seventy-three percent of patients with MGN were treated by endoscopic resection. During follow-up, two patients with MGN died of gastric cancer with lymph node metastasis. The disease-specific survival rate was significantly lower in patients with MGN than that in patients without MGN (94.6% vs. 99.6%, P = 0.006).
The MGN rate gradually increased with follow-up time within 99 months after curative gastric ESD. Thus, regular and long-term surveillance endoscopy may be helpful, especially for patients with initial multiple neoplasms.</abstract><cop>China</cop><pub>Lippincott Williams & Wilkins</pub><pmid>34608068</pmid><doi>10.1097/CM9.0000000000001762</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Atrophy Biopsy Cancer therapies Endoscopic Mucosal Resection Endoscopy Gastric cancer Gastric Mucosa - surgery Gastrointestinal surgery Histology Humans Infections Lymphatic system Metastasis Neoplasms, Second Primary - surgery Original Patients Retrospective Studies Stomach Neoplasms - surgery Treatment Outcome Tumors |
title | Characteristics of metachronous gastric neoplasms after curative endoscopic submucosal dissection for early gastric neoplasms |
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