Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2017; 23(24): 4407-4415
Published online Jun 28, 2017. doi: 10.3748/wjg.v23.i24.4407
Risk factors for metachronous gastric carcinoma development after endoscopic resection of gastric dysplasia: Retrospective, single-center study
Hee Seok Moon, Gee Young Yun, Ju Seok Kim, Hyuk Soo Eun, Sun Hyung Kang, Jae Kyu Sung, Hyun Yong Jeong, Kyu-Sang Song
Hee Seok Moon, Gee Young Yun, Ju Seok Kim, Hyuk Soo Eun, Sun Hyung Kang, Jae Kyu Sung, Hyun Yong Jeong, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon 35015, South Korea
Kyu-Sang Song, Department of Pathology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon 35015, South Korea
Author contributions: Moon HS interpreted and analyzed the data and wrote the manuscript; Sung JK designed, organized, and supervised writing of the manuscript; Kang SH and Jeong HY helped with data interpretation that was used in the current study; Yun GY and Kim JS provided input and organized the data for statistical analysis; Eun HS helped with data analysis; Song KS confirmed the pathology; all authors approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Chungnam National University Hospital Institutional Review Board (IRB file No. 2017-01-033).
Informed consent statement: This study is a retrospective study using medical records, and personal information protection measures are appropriately established so that the informed consent of the subject can be exempted.
Conflict-of-interest statement: We have no conflicts of interest regarding the current paper.
Data sharing statement: No additional data are available
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jae Kyu Sung, MD, PhD, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon 35015, South Korea. jksung69@cnuh.co.kr
Telephone: +82-42-2807186 Fax: +82-42-2544553
Received: February 16, 2017
Peer-review started: February 17, 2017
First decision: March 22, 2017
Revised: April 4, 2017
Accepted: May 19, 2017
Article in press: May 19, 2017
Published online: June 28, 2017
Abstract
AIM

To determine the gastric adenocarcinoma (GAC) occurrence rate and related factors, we evaluated the follow-up results of patients confirmed to have gastric dysplasia after endoscopic resection (ER).

METHODS

We retrospectively analyzed the medical records, endoscopic examination records, endoscopic procedure records, and histological records of 667 cases from 641 patients who were followed-up for at least 12 mo, from among 1273 patients who were conformed to have gastric dysplasia after Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) of gastric mucosal lesions between January 2007 and August 2013 at the Chungnam National University Hospital.

RESULTS

The mean follow-up period was 33.8 mo, and the median follow-up period was 29 mo (range: 12-87). During the follow-up period, the occurrence of metachronous GAC was 4.0% (27/667). The mean and median interval periods between the occurrence of metachronous GAC and endoscopic treatment of gastric dysplasia were 36.3 and 34 mo, respectively (range: 16-71). The factors related to metachronous GAC occurrence after ER for gastric dysplasia were male sex (5.3% vs 1.0%), open-type atrophic gastritis (9.5% vs 3.4%), intestinal metaplasia (6.8% vs 2.4%), and high-grade dysplasia (HGD; 8.4% vs 3.2%). Among them, male sex [OR: 5.05 (1.18-21.68), P = 0.029], intestinal metaplasia [OR: 2.78 (1.24-6.23), P = 0.013], and HGD [OR: 2.70 (1.16-6.26), P = 0.021] were independent related factors in multivariate analysis. Furthermore, 24 of 27 GAC cases (88.9%) occurred at sites other than the previous resection sites, and 3 (11.1%) occurred at the same site as the previous resection site.

CONCLUSION

Male sex, intestinal metaplasia, and HGD were significantly related to the occurrence of metachronous GAC after ER of gastric dysplasia, and most GACs occurred at sites other than the previous resection sites.

Keywords: Gastric dysplasia, Neoplasms, Second primary, Endoscopic mucosal resection, Stomach neoplasms

Core tip: Gastric dysplasia is considered a premalignant lesion that can become malignant. Thus, endoscopic resection is preferred not only for the removal of these lesions but also for exact diagnosis. In our study, we investigated the relationship between the occurrence of synchronous and metachronous lesions after endoscopic treatment of gastric dysplasia and various clinical factors during the follow-up period. The incidence rates of synchronous and metachronous neoplasms after endoscopic resection of gastric dysplasia were 12.1% and 13.8%, respectively. In the multivariate analysis, age of < 60 years and intestinal metaplasia were independent risk factors of synchronous neoplasm. For metachronous neoplasm, especially metachronous gastric adenocarcinoma, independent risk factors were male sex, intestinal metaplasia, and high-grade dysplasia.