Long-term outcomes of endoscopic submucosal dissection in comparison to surgery in undifferentiated-type intramucosal gastric cancer using propensity score analysis

Jun Chul Park, Yong Kang Lee, Soon Young Kim, Yunho Roh, Kyu Yeon Hahn, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Hyoung Il Kim, Jae Ho Cheong, Woo Jin Hyung, Sung Hoon Noh

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: The treatment of intramucosal early gastric cancer with undifferentiated-type histologies (UD-EGCs) using endoscopic submucosal dissection (ESD) is controversial. This study aimed to compare the clinical and oncologic long-term outcomes of ESD and surgery for UD-EGCs. Methods: A prospectively collected database of patients who underwent ESD or surgery between January 2006 and December 2012 was established. Patients who diagnosed with UD-EGC and satisfied the expanded indications of ESD were included. Clinical data from 111 patients treated with ESD and 382 patients underwent surgery were analyzed, and 1–1 propensity score-matched 81 pairs of patients were also compared. Results: In both groups, two-thirds of the UD-EGCs had signet ring cell (SRC)-type histology and about 90% of UD-EGCs were flat or depressed types. The mean size of tumors was smaller in ESD group (9.7 vs. 13.2 mm; P OpenSPiltSPi 0.001). After propensity score-matched, case-matching covariates were not significantly different between the groups. Disease-free survival (DFS) was significantly shorter in the ESD group, but overall survival (OS) was not different between the two groups both in overall comparison (DFS; P OpenSPiltSPi 0.001 and OS; P = 0.078) and propensity score-matched analysis (DFS; P OpenSPiltSPi 0.001 and OS; P = 0.850). According to histologic type, OS of SRC histology was not different between the group, both in overall comparison and propensity score-matched analysis (P = 0.286 and P = 0.210). On the other hands, OS of poorly differentiated adenocarcinoma was significantly shorter in ESD group in overall comparison (P = 0.007), but was not as so in propensity score-matched analysis (P = 0.088). Conclusions: ESD might be a complementary option for the treatment of UD-EGCs, especially in those with SRC-type histology based on strict expanded indications. Nonetheless, close endoscopic surveillance is required because of a high incidence of intragastric recurrence.

Original languageEnglish
Pages (from-to)2046-2057
Number of pages12
JournalSurgical endoscopy
Volume32
Issue number4
DOIs
Publication statusPublished - 2018 Apr 1

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Propensity Score
Stomach Neoplasms
Histology
Survival
Disease-Free Survival
Endoscopic Mucosal Resection
Adenocarcinoma
Databases
Recurrence

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Park, Jun Chul ; Lee, Yong Kang ; Kim, Soon Young ; Roh, Yunho ; Hahn, Kyu Yeon ; Shin, Sung Kwan ; Lee, Sang Kil ; Lee, Yong Chan ; Kim, Hyoung Il ; Cheong, Jae Ho ; Hyung, Woo Jin ; Noh, Sung Hoon. / Long-term outcomes of endoscopic submucosal dissection in comparison to surgery in undifferentiated-type intramucosal gastric cancer using propensity score analysis. In: Surgical endoscopy. 2018 ; Vol. 32, No. 4. pp. 2046-2057.
@article{6e57d1ab8d2b4676a68a1484609e335d,
title = "Long-term outcomes of endoscopic submucosal dissection in comparison to surgery in undifferentiated-type intramucosal gastric cancer using propensity score analysis",
abstract = "Background: The treatment of intramucosal early gastric cancer with undifferentiated-type histologies (UD-EGCs) using endoscopic submucosal dissection (ESD) is controversial. This study aimed to compare the clinical and oncologic long-term outcomes of ESD and surgery for UD-EGCs. Methods: A prospectively collected database of patients who underwent ESD or surgery between January 2006 and December 2012 was established. Patients who diagnosed with UD-EGC and satisfied the expanded indications of ESD were included. Clinical data from 111 patients treated with ESD and 382 patients underwent surgery were analyzed, and 1–1 propensity score-matched 81 pairs of patients were also compared. Results: In both groups, two-thirds of the UD-EGCs had signet ring cell (SRC)-type histology and about 90{\%} of UD-EGCs were flat or depressed types. The mean size of tumors was smaller in ESD group (9.7 vs. 13.2 mm; P OpenSPiltSPi 0.001). After propensity score-matched, case-matching covariates were not significantly different between the groups. Disease-free survival (DFS) was significantly shorter in the ESD group, but overall survival (OS) was not different between the two groups both in overall comparison (DFS; P OpenSPiltSPi 0.001 and OS; P = 0.078) and propensity score-matched analysis (DFS; P OpenSPiltSPi 0.001 and OS; P = 0.850). According to histologic type, OS of SRC histology was not different between the group, both in overall comparison and propensity score-matched analysis (P = 0.286 and P = 0.210). On the other hands, OS of poorly differentiated adenocarcinoma was significantly shorter in ESD group in overall comparison (P = 0.007), but was not as so in propensity score-matched analysis (P = 0.088). Conclusions: ESD might be a complementary option for the treatment of UD-EGCs, especially in those with SRC-type histology based on strict expanded indications. Nonetheless, close endoscopic surveillance is required because of a high incidence of intragastric recurrence.",
author = "Park, {Jun Chul} and Lee, {Yong Kang} and Kim, {Soon Young} and Yunho Roh and Hahn, {Kyu Yeon} and Shin, {Sung Kwan} and Lee, {Sang Kil} and Lee, {Yong Chan} and Kim, {Hyoung Il} and Cheong, {Jae Ho} and Hyung, {Woo Jin} and Noh, {Sung Hoon}",
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Long-term outcomes of endoscopic submucosal dissection in comparison to surgery in undifferentiated-type intramucosal gastric cancer using propensity score analysis. / Park, Jun Chul; Lee, Yong Kang; Kim, Soon Young; Roh, Yunho; Hahn, Kyu Yeon; Shin, Sung Kwan; Lee, Sang Kil; Lee, Yong Chan; Kim, Hyoung Il; Cheong, Jae Ho; Hyung, Woo Jin; Noh, Sung Hoon.

In: Surgical endoscopy, Vol. 32, No. 4, 01.04.2018, p. 2046-2057.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-term outcomes of endoscopic submucosal dissection in comparison to surgery in undifferentiated-type intramucosal gastric cancer using propensity score analysis

AU - Park, Jun Chul

AU - Lee, Yong Kang

AU - Kim, Soon Young

AU - Roh, Yunho

AU - Hahn, Kyu Yeon

AU - Shin, Sung Kwan

AU - Lee, Sang Kil

AU - Lee, Yong Chan

AU - Kim, Hyoung Il

AU - Cheong, Jae Ho

AU - Hyung, Woo Jin

AU - Noh, Sung Hoon

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background: The treatment of intramucosal early gastric cancer with undifferentiated-type histologies (UD-EGCs) using endoscopic submucosal dissection (ESD) is controversial. This study aimed to compare the clinical and oncologic long-term outcomes of ESD and surgery for UD-EGCs. Methods: A prospectively collected database of patients who underwent ESD or surgery between January 2006 and December 2012 was established. Patients who diagnosed with UD-EGC and satisfied the expanded indications of ESD were included. Clinical data from 111 patients treated with ESD and 382 patients underwent surgery were analyzed, and 1–1 propensity score-matched 81 pairs of patients were also compared. Results: In both groups, two-thirds of the UD-EGCs had signet ring cell (SRC)-type histology and about 90% of UD-EGCs were flat or depressed types. The mean size of tumors was smaller in ESD group (9.7 vs. 13.2 mm; P OpenSPiltSPi 0.001). After propensity score-matched, case-matching covariates were not significantly different between the groups. Disease-free survival (DFS) was significantly shorter in the ESD group, but overall survival (OS) was not different between the two groups both in overall comparison (DFS; P OpenSPiltSPi 0.001 and OS; P = 0.078) and propensity score-matched analysis (DFS; P OpenSPiltSPi 0.001 and OS; P = 0.850). According to histologic type, OS of SRC histology was not different between the group, both in overall comparison and propensity score-matched analysis (P = 0.286 and P = 0.210). On the other hands, OS of poorly differentiated adenocarcinoma was significantly shorter in ESD group in overall comparison (P = 0.007), but was not as so in propensity score-matched analysis (P = 0.088). Conclusions: ESD might be a complementary option for the treatment of UD-EGCs, especially in those with SRC-type histology based on strict expanded indications. Nonetheless, close endoscopic surveillance is required because of a high incidence of intragastric recurrence.

AB - Background: The treatment of intramucosal early gastric cancer with undifferentiated-type histologies (UD-EGCs) using endoscopic submucosal dissection (ESD) is controversial. This study aimed to compare the clinical and oncologic long-term outcomes of ESD and surgery for UD-EGCs. Methods: A prospectively collected database of patients who underwent ESD or surgery between January 2006 and December 2012 was established. Patients who diagnosed with UD-EGC and satisfied the expanded indications of ESD were included. Clinical data from 111 patients treated with ESD and 382 patients underwent surgery were analyzed, and 1–1 propensity score-matched 81 pairs of patients were also compared. Results: In both groups, two-thirds of the UD-EGCs had signet ring cell (SRC)-type histology and about 90% of UD-EGCs were flat or depressed types. The mean size of tumors was smaller in ESD group (9.7 vs. 13.2 mm; P OpenSPiltSPi 0.001). After propensity score-matched, case-matching covariates were not significantly different between the groups. Disease-free survival (DFS) was significantly shorter in the ESD group, but overall survival (OS) was not different between the two groups both in overall comparison (DFS; P OpenSPiltSPi 0.001 and OS; P = 0.078) and propensity score-matched analysis (DFS; P OpenSPiltSPi 0.001 and OS; P = 0.850). According to histologic type, OS of SRC histology was not different between the group, both in overall comparison and propensity score-matched analysis (P = 0.286 and P = 0.210). On the other hands, OS of poorly differentiated adenocarcinoma was significantly shorter in ESD group in overall comparison (P = 0.007), but was not as so in propensity score-matched analysis (P = 0.088). Conclusions: ESD might be a complementary option for the treatment of UD-EGCs, especially in those with SRC-type histology based on strict expanded indications. Nonetheless, close endoscopic surveillance is required because of a high incidence of intragastric recurrence.

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SN - 0930-2794

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