|
|
|
| Risk factors of postoperative noncurative resection for early gastroesophageal junction cancer after endoscopic submucosal dissection |
| HUANG Xiaojie1, LIN Xiaolu2, LIANG Wei2, LIN Ying2, CHENG Hui2, YANG Shijie2,LIN Haining2, ZHENG Weiping1, DENG Wanyin2#br# |
（1. College of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou Fujian 350122; 2. Digestive Endoscopy Center, Fujian Provincial Hospital, Fuzhou Fujian 350001, China）
|
|
|
|
| Guide |
|
Abstract ［Abstract］Objective： To investigate the risk factors of noncurative resection of earlystage gastroesophageal junction (GEJ) cancer after endoscopic submucosal dissection (ESD). Methods： A total of 114 patients with early GEJ cancer who underwent ESD in the Digestive Endoscopy Center of Fujian Provincial Hospital from October 2016 to September 2020 were selected and divided into the curative resection group and the noncurative resection group, according to the postoperative pathological examination results. The gender, age, tumor diameter, tumor morphology, pathological type, depth of invasion and whether there was ulcer, etc. were compared between the two groups. Logistic regression analysis was used to figure out the related factors that may be associated with non-curative resection. Spearman correlation analysis was performed between the number of independent risk factors and the rate of noncurative resection. Results： There were no significant differences between the two groups in terms of gender, age, lesion shape, lesion location, deep cystic gastritis and background mucositis(all P>0.05), while tumor diameter, submucosal infiltration, ulcer, pathological type and submucosal fibrosis were signifcantly different(all P<0.05). Logistic analysis showed that tumor diameter(>2 cm), submucosal infiltration, ulcer and undifferentiated carcinoma are independent risk factors for noncurative resection of early GEJ cancer. The number of independent risk factors was correlated with the incidence of postoperative noncurative resection (rs=0.492, P<0.01), the more risk factors, the higher non-curative resection rate. Conclusion：Tumor diameter (>2 cm), submucosal infiltration, ulcer and undifferentiated carcinoma are independent risk factors for noncurative resection after ESD for earlystage GEJ cancer; the greater the number of risk factors, the higher the propotion of noncurative resection.
|
|
Received: 21 January 2022
|
| Fund: |
|
|
|
［1］Maric R, Cheng KK. Classification of adenocarcinoma of the oesophagogastric junction［J］. Br J Surg, 1999, 86(8): 1098-1099.
［2］Abe S, Ishihara R, Takahashi H, et al. Longterm outcomes of endoscopic resection and metachronous cancer after endoscopic resection for adenocarcinoma of the esophagogastric junction in Japan［J］. Gastrointest Endosc, 2019, 89(6): 1120-1128.
［3］Liu Y, He S, Zhang Y, et al. Comparing longterm outcomes between endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for type Ⅱ esophagogastric junction neoplasm［J］. Ann Transl Med, 2021, 9(4): 322.
［4］宋雪梅, 沙林玉, 倪永, 等. 内镜黏膜下剥离术治疗早期胃食管交界处癌与胃癌的比较研究［J］. 南京医科大学学报(自然科学版), 2021, 41(5): 701-706.
［5］Lambert R. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002［J］. Gastrointest Endosc, 2003, 58(6): 3-43.
［6］Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3)［J］. Gastric Cancer, 2011, 14(2): 113-123.
［7］Ono H, Yao K, Fujishiro M, et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer［J］. Dig Endosc, 2016, 28(1): 3-15.
［8］Hirasawa K, Kokawa A, Oka H, et al. Superficial adenocarcinoma of the esophagogastric junction: longterm results of endoscopic submucosal dissection［J］. Gastrointest Endosc, 2010, 72(5): 960-966.
［9］Littlrr ER, Gleibermann E. Gastritis cystica polyposa. (Gastric mucosal prolapse at gastroenterostomy site, with cystic and infiltrative epithelial hyperplasia) ［J］. Cancer, 1972, 29(1): 205-209.
［10］Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers［J］. Gastric Cancer, 2000, 3(4): 219-225.
［11］Jang YS, Lee BE, Kim GH, et al. Factors associated with outcomes in endoscopic submucosal dissection of gastric cardia tumors: a retrospective observational study［J］. Medicine, 2015, 94(31): e1201.
［12］Omae M, Fujisaki J, Horiuchi Y, et al. Safety, efficacy, and longterm outcomes for endoscopic submucosal dissection of early esophagogastric junction cancer［J］. Gastric Cancer, 2013, 16(2): 147-154.
［13］Hirasawa K, Kokawa A, Oka H, et al. Risk assessment chart for curability of early gastric cancer with endoscopic submucosal dissection［J］. Gastrointest Endosc, 2011, 74(6): 1268-1275.
［14］Hatta W, Gotoda T, Oyama T, et al. Correction: a scoring system to stratify curability after endoscopic submucosal dissection for early gastric cancer: “eCura system”［J］. Am J Gastroenterol, 2019, 114(12): 1925-1926.
|
|
|
|
