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Is Additional Surgery Always Sufficient for Preventing Recurrence After Endoscopic Submucosal Dissection with Curability C-2 for Early Gastric Cancer?
Background When a lesion does not meet the curative criteria of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), referred to as non-curative resection or curability C-2 in the guidelines, an additional surgery is the standard therapy because of the risk of lymph node metastasis...
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| Published in: | Annals of surgical oncology 2019-10, Vol.26 (11), p.3636-3643 |
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| container_title | Annals of surgical oncology |
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| creator | Hatta, Waku Gotoda, Takuji Oyama, Tsuneo Kawata, Noboru Takahashi, Akiko Oka, Shiro Hoteya, Shu Nakagawa, Masahiro Hirano, Masaaki Esaki, Mitsuru Matsuda, Mitsuru Ohnita, Ken Shimoda, Ryo Yoshida, Motoyuki Dohi, Osamu Takada, Jun Tanaka, Keiko Yamada, Shinya Tsuji, Tsuyotoshi Ito, Hirotaka Aoyagi, Hiroyuki Nakamura, Tomohiro Nakaya, Naoki Shimosegawa, Tooru Masamune, Atsushi |
| description | Background
When a lesion does not meet the curative criteria of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), referred to as non-curative resection or curability C-2 in the guidelines, an additional surgery is the standard therapy because of the risk of lymph node metastasis (LNM).
Objective
This study aimed to identify high-risk patients for recurrence after additional surgery for curability C-2 ESD of EGC.
Methods
This multicenter retrospective cohort study enrolled 1064 patients who underwent additional surgery after curability C-2 ESD for EGC. We evaluated the recurrence rate and the risk factors for recurrence after additional surgery in these patients.
Results
The 5-year recurrence rate after additional surgery was 1.3%. Multivariate Cox analysis revealed that the independent risk factors for recurrence after additional surgery were LNM (hazard ratio [HR] 32.47;
p
|
| doi_str_mv | 10.1245/s10434-019-07579-2 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2289574319</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2289574319</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-f07dcd0606fba9a293a3b373a8e125c2495ba75aed6e485676e872a3300877d63</originalsourceid><addsrcrecordid>eNp9kctu1DAUhi0EoqXwAiyQJTZsAraPL8kKjcJQKlUCcVlbjnNSXGXiwU5a5UV4XjydAhILVr59_2fp_IQ85-w1F1K9yZxJkBXjTcWMMk0lHpBTrsqV1DV_WPZM11UjtDohT3K-ZowbYOoxOQEOUoDRp-TnRaabvg9ziJMb6ZclXWFa6Wa8dWsux2EIPuA00yEm-inhTdmH6Yp-Rr-khJNHuhlmTHQ79TH7uA--pLrd4mMuvnchZ_QHOb0N83faLsl1YQzzSttK3Em3Lo0rPXd5TiXbuqJMb5-SR4MbMz67X8_It_fbr-2H6vLj-UW7uaw8GDVXAzO975lmeuhc40QDDjow4GrkQnkhG9U5oxz2GmWttNFYG-EAGKuN6TWckVdH7z7FHwvm2e5C9jiObsK4ZCtE3SgjgTcFffkPeh2XVIZ2oDQwAVzJQokj5VPMOeFg9ynsXFotZ_bQmj22Zktr9q41K0roxb26TA77P5HfNRUAjkAuT1Np6O_f_9H-ArxCo00</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2263023154</pqid></control><display><type>article</type><title>Is Additional Surgery Always Sufficient for Preventing Recurrence After Endoscopic Submucosal Dissection with Curability C-2 for Early Gastric Cancer?</title><source>Springer Nature</source><creator>Hatta, Waku ; Gotoda, Takuji ; Oyama, Tsuneo ; Kawata, Noboru ; Takahashi, Akiko ; Oka, Shiro ; Hoteya, Shu ; Nakagawa, Masahiro ; Hirano, Masaaki ; Esaki, Mitsuru ; Matsuda, Mitsuru ; Ohnita, Ken ; Shimoda, Ryo ; Yoshida, Motoyuki ; Dohi, Osamu ; Takada, Jun ; Tanaka, Keiko ; Yamada, Shinya ; Tsuji, Tsuyotoshi ; Ito, Hirotaka ; Aoyagi, Hiroyuki ; Nakamura, Tomohiro ; Nakaya, Naoki ; Shimosegawa, Tooru ; Masamune, Atsushi</creator><creatorcontrib>Hatta, Waku ; Gotoda, Takuji ; Oyama, Tsuneo ; Kawata, Noboru ; Takahashi, Akiko ; Oka, Shiro ; Hoteya, Shu ; Nakagawa, Masahiro ; Hirano, Masaaki ; Esaki, Mitsuru ; Matsuda, Mitsuru ; Ohnita, Ken ; Shimoda, Ryo ; Yoshida, Motoyuki ; Dohi, Osamu ; Takada, Jun ; Tanaka, Keiko ; Yamada, Shinya ; Tsuji, Tsuyotoshi ; Ito, Hirotaka ; Aoyagi, Hiroyuki ; Nakamura, Tomohiro ; Nakaya, Naoki ; Shimosegawa, Tooru ; Masamune, Atsushi</creatorcontrib><description>Background
When a lesion does not meet the curative criteria of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), referred to as non-curative resection or curability C-2 in the guidelines, an additional surgery is the standard therapy because of the risk of lymph node metastasis (LNM).
Objective
This study aimed to identify high-risk patients for recurrence after additional surgery for curability C-2 ESD of EGC.
Methods
This multicenter retrospective cohort study enrolled 1064 patients who underwent additional surgery after curability C-2 ESD for EGC. We evaluated the recurrence rate and the risk factors for recurrence after additional surgery in these patients.
Results
The 5-year recurrence rate after additional surgery was 1.3%. Multivariate Cox analysis revealed that the independent risk factors for recurrence after additional surgery were LNM (hazard ratio [HR] 32.47;
p
< 0.001) and vascular invasion (HR 4.75;
p
= 0.014). Moreover, patients with both LNM and vascular invasion had a high rate of recurrence after additional surgery (24.6% in 5 years), with a high HR (119.32) compared with those with neither LNM nor vascular invasion. Among patients with no vascular invasion, a high rate of recurrence was observed in those with N2/N3 disease according to the American Joint Committee on Cancer TNM staging system (27.3% in 5 years), in contrast with no recurrence in those with N1 disease.
Conclusions
Patients with both LNM (N1–N3) and vascular invasion, as well as those with N2/N3 disease but no vascular invasion, would be candidates for adjuvant chemotherapy after additional surgery for curability C-2 ESD of EGC.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-019-07579-2</identifier><identifier>PMID: 31342376</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adenocarcinoma - pathology ; Adenocarcinoma - surgery ; Aged ; Chemotherapy ; Endoscopic Mucosal Resection - mortality ; Endoscopy ; Female ; Follow-Up Studies ; Gastric cancer ; Gastrointestinal Oncology ; Humans ; Lymph nodes ; Male ; Medicine ; Medicine & Public Health ; Metastases ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local - pathology ; Neoplasm Recurrence, Local - prevention & control ; Neoplasm Staging ; Oncology ; Reoperation ; Retrospective Studies ; Risk factors ; Risk groups ; Stomach Neoplasms - pathology ; Stomach Neoplasms - surgery ; Surgery ; Surgical Oncology ; Survival Rate</subject><ispartof>Annals of surgical oncology, 2019-10, Vol.26 (11), p.3636-3643</ispartof><rights>Society of Surgical Oncology 2019</rights><rights>Annals of Surgical Oncology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-f07dcd0606fba9a293a3b373a8e125c2495ba75aed6e485676e872a3300877d63</citedby><cites>FETCH-LOGICAL-c375t-f07dcd0606fba9a293a3b373a8e125c2495ba75aed6e485676e872a3300877d63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31342376$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hatta, Waku</creatorcontrib><creatorcontrib>Gotoda, Takuji</creatorcontrib><creatorcontrib>Oyama, Tsuneo</creatorcontrib><creatorcontrib>Kawata, Noboru</creatorcontrib><creatorcontrib>Takahashi, Akiko</creatorcontrib><creatorcontrib>Oka, Shiro</creatorcontrib><creatorcontrib>Hoteya, Shu</creatorcontrib><creatorcontrib>Nakagawa, Masahiro</creatorcontrib><creatorcontrib>Hirano, Masaaki</creatorcontrib><creatorcontrib>Esaki, Mitsuru</creatorcontrib><creatorcontrib>Matsuda, Mitsuru</creatorcontrib><creatorcontrib>Ohnita, Ken</creatorcontrib><creatorcontrib>Shimoda, Ryo</creatorcontrib><creatorcontrib>Yoshida, Motoyuki</creatorcontrib><creatorcontrib>Dohi, Osamu</creatorcontrib><creatorcontrib>Takada, Jun</creatorcontrib><creatorcontrib>Tanaka, Keiko</creatorcontrib><creatorcontrib>Yamada, Shinya</creatorcontrib><creatorcontrib>Tsuji, Tsuyotoshi</creatorcontrib><creatorcontrib>Ito, Hirotaka</creatorcontrib><creatorcontrib>Aoyagi, Hiroyuki</creatorcontrib><creatorcontrib>Nakamura, Tomohiro</creatorcontrib><creatorcontrib>Nakaya, Naoki</creatorcontrib><creatorcontrib>Shimosegawa, Tooru</creatorcontrib><creatorcontrib>Masamune, Atsushi</creatorcontrib><title>Is Additional Surgery Always Sufficient for Preventing Recurrence After Endoscopic Submucosal Dissection with Curability C-2 for Early Gastric Cancer?</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
When a lesion does not meet the curative criteria of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), referred to as non-curative resection or curability C-2 in the guidelines, an additional surgery is the standard therapy because of the risk of lymph node metastasis (LNM).
Objective
This study aimed to identify high-risk patients for recurrence after additional surgery for curability C-2 ESD of EGC.
Methods
This multicenter retrospective cohort study enrolled 1064 patients who underwent additional surgery after curability C-2 ESD for EGC. We evaluated the recurrence rate and the risk factors for recurrence after additional surgery in these patients.
Results
The 5-year recurrence rate after additional surgery was 1.3%. Multivariate Cox analysis revealed that the independent risk factors for recurrence after additional surgery were LNM (hazard ratio [HR] 32.47;
p
< 0.001) and vascular invasion (HR 4.75;
p
= 0.014). Moreover, patients with both LNM and vascular invasion had a high rate of recurrence after additional surgery (24.6% in 5 years), with a high HR (119.32) compared with those with neither LNM nor vascular invasion. Among patients with no vascular invasion, a high rate of recurrence was observed in those with N2/N3 disease according to the American Joint Committee on Cancer TNM staging system (27.3% in 5 years), in contrast with no recurrence in those with N1 disease.
Conclusions
Patients with both LNM (N1–N3) and vascular invasion, as well as those with N2/N3 disease but no vascular invasion, would be candidates for adjuvant chemotherapy after additional surgery for curability C-2 ESD of EGC.</description><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - surgery</subject><subject>Aged</subject><subject>Chemotherapy</subject><subject>Endoscopic Mucosal Resection - mortality</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastric cancer</subject><subject>Gastrointestinal Oncology</subject><subject>Humans</subject><subject>Lymph nodes</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Middle Aged</subject><subject>Neoplasm Invasiveness</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Recurrence, Local - prevention & control</subject><subject>Neoplasm Staging</subject><subject>Oncology</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Risk groups</subject><subject>Stomach Neoplasms - pathology</subject><subject>Stomach Neoplasms - surgery</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival Rate</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kctu1DAUhi0EoqXwAiyQJTZsAraPL8kKjcJQKlUCcVlbjnNSXGXiwU5a5UV4XjydAhILVr59_2fp_IQ85-w1F1K9yZxJkBXjTcWMMk0lHpBTrsqV1DV_WPZM11UjtDohT3K-ZowbYOoxOQEOUoDRp-TnRaabvg9ziJMb6ZclXWFa6Wa8dWsux2EIPuA00yEm-inhTdmH6Yp-Rr-khJNHuhlmTHQ79TH7uA--pLrd4mMuvnchZ_QHOb0N83faLsl1YQzzSttK3Em3Lo0rPXd5TiXbuqJMb5-SR4MbMz67X8_It_fbr-2H6vLj-UW7uaw8GDVXAzO975lmeuhc40QDDjow4GrkQnkhG9U5oxz2GmWttNFYG-EAGKuN6TWckVdH7z7FHwvm2e5C9jiObsK4ZCtE3SgjgTcFffkPeh2XVIZ2oDQwAVzJQokj5VPMOeFg9ynsXFotZ_bQmj22Zktr9q41K0roxb26TA77P5HfNRUAjkAuT1Np6O_f_9H-ArxCo00</recordid><startdate>20191001</startdate><enddate>20191001</enddate><creator>Hatta, Waku</creator><creator>Gotoda, Takuji</creator><creator>Oyama, Tsuneo</creator><creator>Kawata, Noboru</creator><creator>Takahashi, Akiko</creator><creator>Oka, Shiro</creator><creator>Hoteya, Shu</creator><creator>Nakagawa, Masahiro</creator><creator>Hirano, Masaaki</creator><creator>Esaki, Mitsuru</creator><creator>Matsuda, Mitsuru</creator><creator>Ohnita, Ken</creator><creator>Shimoda, Ryo</creator><creator>Yoshida, Motoyuki</creator><creator>Dohi, Osamu</creator><creator>Takada, Jun</creator><creator>Tanaka, Keiko</creator><creator>Yamada, Shinya</creator><creator>Tsuji, Tsuyotoshi</creator><creator>Ito, Hirotaka</creator><creator>Aoyagi, Hiroyuki</creator><creator>Nakamura, Tomohiro</creator><creator>Nakaya, Naoki</creator><creator>Shimosegawa, Tooru</creator><creator>Masamune, Atsushi</creator><general>Springer International Publishing</general><general>Springer Nature B.V</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>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20191001</creationdate><title>Is Additional Surgery Always Sufficient for Preventing Recurrence After Endoscopic Submucosal Dissection with Curability C-2 for Early Gastric Cancer?</title><author>Hatta, Waku ; Gotoda, Takuji ; Oyama, Tsuneo ; Kawata, Noboru ; Takahashi, Akiko ; Oka, Shiro ; Hoteya, Shu ; Nakagawa, Masahiro ; Hirano, Masaaki ; Esaki, Mitsuru ; Matsuda, Mitsuru ; Ohnita, Ken ; Shimoda, Ryo ; Yoshida, Motoyuki ; Dohi, Osamu ; Takada, Jun ; Tanaka, Keiko ; Yamada, Shinya ; Tsuji, Tsuyotoshi ; Ito, Hirotaka ; Aoyagi, Hiroyuki ; Nakamura, Tomohiro ; Nakaya, Naoki ; Shimosegawa, Tooru ; Masamune, Atsushi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-f07dcd0606fba9a293a3b373a8e125c2495ba75aed6e485676e872a3300877d63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adenocarcinoma - 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Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hatta, Waku</au><au>Gotoda, Takuji</au><au>Oyama, Tsuneo</au><au>Kawata, Noboru</au><au>Takahashi, Akiko</au><au>Oka, Shiro</au><au>Hoteya, Shu</au><au>Nakagawa, Masahiro</au><au>Hirano, Masaaki</au><au>Esaki, Mitsuru</au><au>Matsuda, Mitsuru</au><au>Ohnita, Ken</au><au>Shimoda, Ryo</au><au>Yoshida, Motoyuki</au><au>Dohi, Osamu</au><au>Takada, Jun</au><au>Tanaka, Keiko</au><au>Yamada, Shinya</au><au>Tsuji, Tsuyotoshi</au><au>Ito, Hirotaka</au><au>Aoyagi, Hiroyuki</au><au>Nakamura, Tomohiro</au><au>Nakaya, Naoki</au><au>Shimosegawa, Tooru</au><au>Masamune, Atsushi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is Additional Surgery Always Sufficient for Preventing Recurrence After Endoscopic Submucosal Dissection with Curability C-2 for Early Gastric Cancer?</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2019-10-01</date><risdate>2019</risdate><volume>26</volume><issue>11</issue><spage>3636</spage><epage>3643</epage><pages>3636-3643</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
When a lesion does not meet the curative criteria of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), referred to as non-curative resection or curability C-2 in the guidelines, an additional surgery is the standard therapy because of the risk of lymph node metastasis (LNM).
Objective
This study aimed to identify high-risk patients for recurrence after additional surgery for curability C-2 ESD of EGC.
Methods
This multicenter retrospective cohort study enrolled 1064 patients who underwent additional surgery after curability C-2 ESD for EGC. We evaluated the recurrence rate and the risk factors for recurrence after additional surgery in these patients.
Results
The 5-year recurrence rate after additional surgery was 1.3%. Multivariate Cox analysis revealed that the independent risk factors for recurrence after additional surgery were LNM (hazard ratio [HR] 32.47;
p
< 0.001) and vascular invasion (HR 4.75;
p
= 0.014). Moreover, patients with both LNM and vascular invasion had a high rate of recurrence after additional surgery (24.6% in 5 years), with a high HR (119.32) compared with those with neither LNM nor vascular invasion. Among patients with no vascular invasion, a high rate of recurrence was observed in those with N2/N3 disease according to the American Joint Committee on Cancer TNM staging system (27.3% in 5 years), in contrast with no recurrence in those with N1 disease.
Conclusions
Patients with both LNM (N1–N3) and vascular invasion, as well as those with N2/N3 disease but no vascular invasion, would be candidates for adjuvant chemotherapy after additional surgery for curability C-2 ESD of EGC.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>31342376</pmid><doi>10.1245/s10434-019-07579-2</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2019-10, Vol.26 (11), p.3636-3643 |
| issn | 1068-9265 1534-4681 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2289574319 |
| source | Springer Nature |
| subjects | Adenocarcinoma - pathology Adenocarcinoma - surgery Aged Chemotherapy Endoscopic Mucosal Resection - mortality Endoscopy Female Follow-Up Studies Gastric cancer Gastrointestinal Oncology Humans Lymph nodes Male Medicine Medicine & Public Health Metastases Middle Aged Neoplasm Invasiveness Neoplasm Recurrence, Local - pathology Neoplasm Recurrence, Local - prevention & control Neoplasm Staging Oncology Reoperation Retrospective Studies Risk factors Risk groups Stomach Neoplasms - pathology Stomach Neoplasms - surgery Surgery Surgical Oncology Survival Rate |
| title | Is Additional Surgery Always Sufficient for Preventing Recurrence After Endoscopic Submucosal Dissection with Curability C-2 for Early Gastric Cancer? |
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