Loading…
Outcomes after endoscopic local excision of early-stage gastric adenocarcinoma in the United States
Local excision (LE) for early-stage gastric cancer has expanded in the United States over recent years, however, national outcomes are unknown. The objective of the study was to evaluate national survival outcomes following LE for early-stage gastric cancer. Patients with resectable gastric adenocar...
Saved in:
| Published in: | Surgical oncology 2023-06, Vol.48, p.101937-101937, Article 101937 |
|---|---|
| Main Authors: | , , , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | |
|---|---|
| cites | cdi_FETCH-LOGICAL-c311t-69afc9582ba10ea1dd0b368c7888e799284f6c1500b6a5487e646f8f7e6c16a63 |
| container_end_page | 101937 |
| container_issue | |
| container_start_page | 101937 |
| container_title | Surgical oncology |
| container_volume | 48 |
| creator | Newland, John J. Johnson, Abree M. Feng, Zhaoyong Kim, Raymond E. Williams, Richelle T. Hanna, Nader N. Mullins, C. Daniel Hu, Yinin |
| description | Local excision (LE) for early-stage gastric cancer has expanded in the United States over recent years, however, national outcomes are unknown. The objective of the study was to evaluate national survival outcomes following LE for early-stage gastric cancer.
Patients with resectable gastric adenocarcinoma between 2010 and 2016 were identified from the National Cancer Database then classified by LE curability into eCuraA (high) and eCuraC (low) according to Japanese Gastric Cancer Association guidelines. Demographics, clinical/provider descriptors, and perioperative/survival outcomes were extracted. Propensity-weighted cox proportional hazards regression assessed factors associated with overall survival.
Patients were stratified into eCuraA (N = 1167) and eCuraC (N = 13,905) subgroups. Postoperative 30-day mortality (0% vs 2.8%, p |
| doi_str_mv | 10.1016/j.suronc.2023.101937 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2801980952</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0960740423000373</els_id><sourcerecordid>2801980952</sourcerecordid><originalsourceid>FETCH-LOGICAL-c311t-69afc9582ba10ea1dd0b368c7888e799284f6c1500b6a5487e646f8f7e6c16a63</originalsourceid><addsrcrecordid>eNp9kE1v1DAQhi0EotvCP0DIRy5Zxk7ijwsSqvioVKkH6NnyTibFq8RebAfRf09WKRw5jTR63nk1D2NvBOwFCPX-uC9LThH3EmR7XtlWP2M7YbRt2lbCc7YDq6DRHXQX7LKUIwAoLcVLdtFq6I3VcsfwbqmYZircj5UypzikgukUkE8J_cTpN4YSUuRp5OTz9NiU6h-IP_hS80r5geIKZgwxzZ6HyOsP4vcxVBr4t-orlVfsxeinQq-f5hW7__zp-_XX5vbuy831x9sGWyFqo6wf0fZGHrwA8mIY4NAqg9oYQ9paabpRoegBDsr3ndGkOjWacZ0olFftFXu33T3l9HOhUt0cCtI0-UhpKU6aVZIB28sV7TYUcyol0-hOOcw-PzoB7qzXHd2m1531uk3vGnv71LAcZhr-hf76XIEPG0Drn78CZVcwUEQaQiasbkjh_w1_AKxljmA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2801980952</pqid></control><display><type>article</type><title>Outcomes after endoscopic local excision of early-stage gastric adenocarcinoma in the United States</title><source>ScienceDirect Freedom Collection</source><creator>Newland, John J. ; Johnson, Abree M. ; Feng, Zhaoyong ; Kim, Raymond E. ; Williams, Richelle T. ; Hanna, Nader N. ; Mullins, C. Daniel ; Hu, Yinin</creator><creatorcontrib>Newland, John J. ; Johnson, Abree M. ; Feng, Zhaoyong ; Kim, Raymond E. ; Williams, Richelle T. ; Hanna, Nader N. ; Mullins, C. Daniel ; Hu, Yinin</creatorcontrib><description>Local excision (LE) for early-stage gastric cancer has expanded in the United States over recent years, however, national outcomes are unknown. The objective of the study was to evaluate national survival outcomes following LE for early-stage gastric cancer.
Patients with resectable gastric adenocarcinoma between 2010 and 2016 were identified from the National Cancer Database then classified by LE curability into eCuraA (high) and eCuraC (low) according to Japanese Gastric Cancer Association guidelines. Demographics, clinical/provider descriptors, and perioperative/survival outcomes were extracted. Propensity-weighted cox proportional hazards regression assessed factors associated with overall survival.
Patients were stratified into eCuraA (N = 1167) and eCuraC (N = 13,905) subgroups. Postoperative 30-day mortality (0% vs 2.8%, p < 0.001) and readmission (2.3% vs 7.8%, p = 0.005) favored LE. Local excision was not associated with survival on propensity-weighted analyses. However, among eCuraC patients, LE was associated with higher likelihood of positive margins (27.1% vs 7.0%, p < 0.001), which was the strongest predictor of poor survival (HR 2.0, p < 0.001).
Although early morbidity is low, oncologic outcomes following LE are compromised for eCuraC patients. These findings support careful patient selection and treatment centralization in the early adoption phase of LE for gastric cancer.
•Local excision has lower morbidity and mortality than radical resection.•Carefully selected gastric cancer patients have good survival after local excision.•Local excision for inappropriate candidates has a high margin positivity rate.•Margin positivity is associated with poor survival in early gastric cancer.</description><identifier>ISSN: 0960-7404</identifier><identifier>EISSN: 1879-3320</identifier><identifier>DOI: 10.1016/j.suronc.2023.101937</identifier><identifier>PMID: 37058972</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Adenocarcinoma - pathology ; Digestive System Surgical Procedures ; Gastric cancer ; Humans ; Local excision ; Neoplasm Staging ; Outcomes ; Rectal Neoplasms - pathology ; Retrospective Studies ; Stomach Neoplasms - pathology ; Survival ; Treatment Outcome ; United States - epidemiology</subject><ispartof>Surgical oncology, 2023-06, Vol.48, p.101937-101937, Article 101937</ispartof><rights>2023</rights><rights>Published by Elsevier Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c311t-69afc9582ba10ea1dd0b368c7888e799284f6c1500b6a5487e646f8f7e6c16a63</cites><orcidid>0000-0002-4324-9530 ; 0000-0002-3931-0861 ; 0000-0003-3057-8316</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37058972$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Newland, John J.</creatorcontrib><creatorcontrib>Johnson, Abree M.</creatorcontrib><creatorcontrib>Feng, Zhaoyong</creatorcontrib><creatorcontrib>Kim, Raymond E.</creatorcontrib><creatorcontrib>Williams, Richelle T.</creatorcontrib><creatorcontrib>Hanna, Nader N.</creatorcontrib><creatorcontrib>Mullins, C. Daniel</creatorcontrib><creatorcontrib>Hu, Yinin</creatorcontrib><title>Outcomes after endoscopic local excision of early-stage gastric adenocarcinoma in the United States</title><title>Surgical oncology</title><addtitle>Surg Oncol</addtitle><description>Local excision (LE) for early-stage gastric cancer has expanded in the United States over recent years, however, national outcomes are unknown. The objective of the study was to evaluate national survival outcomes following LE for early-stage gastric cancer.
Patients with resectable gastric adenocarcinoma between 2010 and 2016 were identified from the National Cancer Database then classified by LE curability into eCuraA (high) and eCuraC (low) according to Japanese Gastric Cancer Association guidelines. Demographics, clinical/provider descriptors, and perioperative/survival outcomes were extracted. Propensity-weighted cox proportional hazards regression assessed factors associated with overall survival.
Patients were stratified into eCuraA (N = 1167) and eCuraC (N = 13,905) subgroups. Postoperative 30-day mortality (0% vs 2.8%, p < 0.001) and readmission (2.3% vs 7.8%, p = 0.005) favored LE. Local excision was not associated with survival on propensity-weighted analyses. However, among eCuraC patients, LE was associated with higher likelihood of positive margins (27.1% vs 7.0%, p < 0.001), which was the strongest predictor of poor survival (HR 2.0, p < 0.001).
Although early morbidity is low, oncologic outcomes following LE are compromised for eCuraC patients. These findings support careful patient selection and treatment centralization in the early adoption phase of LE for gastric cancer.
•Local excision has lower morbidity and mortality than radical resection.•Carefully selected gastric cancer patients have good survival after local excision.•Local excision for inappropriate candidates has a high margin positivity rate.•Margin positivity is associated with poor survival in early gastric cancer.</description><subject>Adenocarcinoma - pathology</subject><subject>Digestive System Surgical Procedures</subject><subject>Gastric cancer</subject><subject>Humans</subject><subject>Local excision</subject><subject>Neoplasm Staging</subject><subject>Outcomes</subject><subject>Rectal Neoplasms - pathology</subject><subject>Retrospective Studies</subject><subject>Stomach Neoplasms - pathology</subject><subject>Survival</subject><subject>Treatment Outcome</subject><subject>United States - epidemiology</subject><issn>0960-7404</issn><issn>1879-3320</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kE1v1DAQhi0EotvCP0DIRy5Zxk7ijwsSqvioVKkH6NnyTibFq8RebAfRf09WKRw5jTR63nk1D2NvBOwFCPX-uC9LThH3EmR7XtlWP2M7YbRt2lbCc7YDq6DRHXQX7LKUIwAoLcVLdtFq6I3VcsfwbqmYZircj5UypzikgukUkE8J_cTpN4YSUuRp5OTz9NiU6h-IP_hS80r5geIKZgwxzZ6HyOsP4vcxVBr4t-orlVfsxeinQq-f5hW7__zp-_XX5vbuy831x9sGWyFqo6wf0fZGHrwA8mIY4NAqg9oYQ9paabpRoegBDsr3ndGkOjWacZ0olFftFXu33T3l9HOhUt0cCtI0-UhpKU6aVZIB28sV7TYUcyol0-hOOcw-PzoB7qzXHd2m1531uk3vGnv71LAcZhr-hf76XIEPG0Drn78CZVcwUEQaQiasbkjh_w1_AKxljmA</recordid><startdate>202306</startdate><enddate>202306</enddate><creator>Newland, John J.</creator><creator>Johnson, Abree M.</creator><creator>Feng, Zhaoyong</creator><creator>Kim, Raymond E.</creator><creator>Williams, Richelle T.</creator><creator>Hanna, Nader N.</creator><creator>Mullins, C. Daniel</creator><creator>Hu, Yinin</creator><general>Elsevier Ltd</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>7X8</scope><orcidid>https://orcid.org/0000-0002-4324-9530</orcidid><orcidid>https://orcid.org/0000-0002-3931-0861</orcidid><orcidid>https://orcid.org/0000-0003-3057-8316</orcidid></search><sort><creationdate>202306</creationdate><title>Outcomes after endoscopic local excision of early-stage gastric adenocarcinoma in the United States</title><author>Newland, John J. ; Johnson, Abree M. ; Feng, Zhaoyong ; Kim, Raymond E. ; Williams, Richelle T. ; Hanna, Nader N. ; Mullins, C. Daniel ; Hu, Yinin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c311t-69afc9582ba10ea1dd0b368c7888e799284f6c1500b6a5487e646f8f7e6c16a63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adenocarcinoma - pathology</topic><topic>Digestive System Surgical Procedures</topic><topic>Gastric cancer</topic><topic>Humans</topic><topic>Local excision</topic><topic>Neoplasm Staging</topic><topic>Outcomes</topic><topic>Rectal Neoplasms - pathology</topic><topic>Retrospective Studies</topic><topic>Stomach Neoplasms - pathology</topic><topic>Survival</topic><topic>Treatment Outcome</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Newland, John J.</creatorcontrib><creatorcontrib>Johnson, Abree M.</creatorcontrib><creatorcontrib>Feng, Zhaoyong</creatorcontrib><creatorcontrib>Kim, Raymond E.</creatorcontrib><creatorcontrib>Williams, Richelle T.</creatorcontrib><creatorcontrib>Hanna, Nader N.</creatorcontrib><creatorcontrib>Mullins, C. Daniel</creatorcontrib><creatorcontrib>Hu, Yinin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Newland, John J.</au><au>Johnson, Abree M.</au><au>Feng, Zhaoyong</au><au>Kim, Raymond E.</au><au>Williams, Richelle T.</au><au>Hanna, Nader N.</au><au>Mullins, C. Daniel</au><au>Hu, Yinin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes after endoscopic local excision of early-stage gastric adenocarcinoma in the United States</atitle><jtitle>Surgical oncology</jtitle><addtitle>Surg Oncol</addtitle><date>2023-06</date><risdate>2023</risdate><volume>48</volume><spage>101937</spage><epage>101937</epage><pages>101937-101937</pages><artnum>101937</artnum><issn>0960-7404</issn><eissn>1879-3320</eissn><abstract>Local excision (LE) for early-stage gastric cancer has expanded in the United States over recent years, however, national outcomes are unknown. The objective of the study was to evaluate national survival outcomes following LE for early-stage gastric cancer.
Patients with resectable gastric adenocarcinoma between 2010 and 2016 were identified from the National Cancer Database then classified by LE curability into eCuraA (high) and eCuraC (low) according to Japanese Gastric Cancer Association guidelines. Demographics, clinical/provider descriptors, and perioperative/survival outcomes were extracted. Propensity-weighted cox proportional hazards regression assessed factors associated with overall survival.
Patients were stratified into eCuraA (N = 1167) and eCuraC (N = 13,905) subgroups. Postoperative 30-day mortality (0% vs 2.8%, p < 0.001) and readmission (2.3% vs 7.8%, p = 0.005) favored LE. Local excision was not associated with survival on propensity-weighted analyses. However, among eCuraC patients, LE was associated with higher likelihood of positive margins (27.1% vs 7.0%, p < 0.001), which was the strongest predictor of poor survival (HR 2.0, p < 0.001).
Although early morbidity is low, oncologic outcomes following LE are compromised for eCuraC patients. These findings support careful patient selection and treatment centralization in the early adoption phase of LE for gastric cancer.
•Local excision has lower morbidity and mortality than radical resection.•Carefully selected gastric cancer patients have good survival after local excision.•Local excision for inappropriate candidates has a high margin positivity rate.•Margin positivity is associated with poor survival in early gastric cancer.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>37058972</pmid><doi>10.1016/j.suronc.2023.101937</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-4324-9530</orcidid><orcidid>https://orcid.org/0000-0002-3931-0861</orcidid><orcidid>https://orcid.org/0000-0003-3057-8316</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0960-7404 |
| ispartof | Surgical oncology, 2023-06, Vol.48, p.101937-101937, Article 101937 |
| issn | 0960-7404 1879-3320 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2801980952 |
| source | ScienceDirect Freedom Collection |
| subjects | Adenocarcinoma - pathology Digestive System Surgical Procedures Gastric cancer Humans Local excision Neoplasm Staging Outcomes Rectal Neoplasms - pathology Retrospective Studies Stomach Neoplasms - pathology Survival Treatment Outcome United States - epidemiology |
| title | Outcomes after endoscopic local excision of early-stage gastric adenocarcinoma in the United States |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-19T20%3A21%3A34IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Outcomes%20after%20endoscopic%20local%20excision%20of%20early-stage%20gastric%20adenocarcinoma%20in%20the%20United%20States&rft.jtitle=Surgical%20oncology&rft.au=Newland,%20John%20J.&rft.date=2023-06&rft.volume=48&rft.spage=101937&rft.epage=101937&rft.pages=101937-101937&rft.artnum=101937&rft.issn=0960-7404&rft.eissn=1879-3320&rft_id=info:doi/10.1016/j.suronc.2023.101937&rft_dat=%3Cproquest_cross%3E2801980952%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c311t-69afc9582ba10ea1dd0b368c7888e799284f6c1500b6a5487e646f8f7e6c16a63%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2801980952&rft_id=info:pmid/37058972&rfr_iscdi=true |