Clinical Outcomes of Metachronous Gastric Cancer after Endoscopic Resection for Early Gastric Cancer

• Published in: Gut and liver 2020, 14(2), , pp.190-198
• Main Authors: Kim, Jue Lie, Kim, Sang Gyun, Kim, Jung, Park, Jae Yong, Yang, Hyo-Joon, Kim, Hyun Ju, Chung, Hyunsoo
• Format: Article
• Language: English
• Subjects: Aged; Body Mass Index; early gastric cancer; Endoscopic Mucosal Resection - adverse effects; endoscopic submucosal dissection; Female; Humans; Male; metachronous gastric cancer; Middle Aged; Multivariate Analysis; Neoplasms, Second Primary - etiology; Original; Postoperative Complications - etiology; Retrospective Studies; Risk Factors; Stomach Neoplasms - etiology; Stomach Neoplasms - surgery; surgery; survival rate; Treatment Outcome; 내과학
• ISSN: 1976-2283; 2005-1212
• DOI: 10.5009/gnl18575

Patients treated with endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) are at risk of developing metachronous gastric cancer (MGC). The aim of this study was to evaluate the clinical outcomes of MGC after ESD for EGC between the re-ESD and surgery groups. In total, data from 1,510 patients who underwent ESD for EGC from January 2005 to May 2014 were retrospectively reviewed, and data from 112 patients with MGC were analyzed according to the type of treatment, namely, re-ESD and surgery. The clinicopathological factors affecting the subsequent treatment and outcomes of MGC were evaluated. The median duration to the development of MGC was 47 months. In multivariate analysis, lower body mass index (BMI) (p=0.037) and multiplicity (p=0.014) of index cases were significantly associated with subsequent surgery for MGC. In cases of MGC, a diffuse or mixed-type Lauren classification (p=0.009), the depth of tumor mucosal invasion (p=0.001), and an upper stomach location (p=0.049) were associated with surgery. Overall survival was significantly shorter in the surgery group than in the re-ESD group after treatment for MGC (log-rank test, p=0.01). Lower BMI and multiplicity of index cancers were significantly associated with the surgical resection of MGC. Close follow-up is needed to minimize additional treatment for cases at high risk of advanced MGC after ESD for EGC.