Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2024; 30(14): 1990-2005
Published online Apr 14, 2024. doi: 10.3748/wjg.v30.i14.1990
Characteristics of early gastric tumors with different differentiation and predictors of long-term outcomes after endoscopic submucosal dissection
Hong-Yi Zhu, Jie Wu, Yuan-Miao Zhang, Fang-Lan Li, Jin Yang, Bin Qin, Jiong Jiang, Ning Zhu, Meng-Yao Chen, Bai-Cang Zou
Hong-Yi Zhu, Yuan-Miao Zhang, Bin Qin, Jiong Jiang, Ning Zhu, Meng-Yao Chen, Bai-Cang Zou, Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
Jie Wu, Department of Pathology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
Fang-Lan Li, Department of Gastroenterology, Xianyang Hospital of Yan'an University, Xianyang 712000, Shaanxi Province, China
Jin Yang, Department of Gastroenterology, The First Hospital of Xi'an, Xi'an 710000, Shaanxi Province, China
Author contributions: Zhu HY wrote the article and collected the data; Wu J offered help with pathology; Zhang YM, Li FL, Yang J, Jiang J, Qin B, Zhu N, Chen MY analysis and interpretation; Zou BC designed the study, revised the paper critically for important intellectual content; all the authors approved the final version of the article to be published.
Supported by Development Program of Shaanxi Province, No. 2021SF-221.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The Second Affiliated Hospital of Xi'an Jiaotong university.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bai-Cang Zou, PhD, Chief Physician, Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 West Fifth Road, Xi'an 710004, Shaanxi Province, China. zoubaicang2@163.com
Received: December 21, 2023
Peer-review started: December 21, 2023
First decision: January 30, 2024
Revised: February 12, 2024
Accepted: March 19, 2024
Article in press: March 19, 2024
Published online: April 14, 2024
Processing time: 113 Days and 3.6 Hours
Abstract
BACKGROUND

Gastric cancer is a common malignant tumor of the digestive tract, and endoscopic submucosal dissection (ESD) is the preferred treatment for early-stage gastric cancer. The analysis of the epidemiological characteristics of gastric mucosal tumors with different differentiation degrees and the influencing factors of long-term ESD efficacy may have certain significance for revealing the development of gastric cancer and ESD.

AIM

To analyze the features of gastric mucosal tumors at different differentiation levels, and to explore the prognostic factors of ESD.

METHODS

We retrospectively studied 301 lesions in 285 patients at The Second Affiliated Hospital of Xi'an Jiaotong University from 2014 to 2021, according to the latest Japanese guidelines (sixth edition), and divided them into low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN), and differentiated and undifferentiated early carcinoma. They are followed up by endoscopy, chest and abdominal computed tomography at 3, 6 and 12 months after ESD. We compared clinicopathologic characteristics, ESD efficacy, and complications with different degrees of differentiation, and analyzed the related factors associated with ESD.

RESULTS

HGIN and differentiated carcinoma patients were significantly older compared with LGIN patients (P < 0.001) and accounted for more 0-IIc (P < 0.001), atrophic gastritis was common (P < 0.001), and irregular microvascular patterns (IMVPs) and demarcation lines (DLs) were more obvious (P < 0.001). There was more infiltration in the undifferentiated carcinoma tissue (P < 0.001), more abnormal folds and poorer mucosal peristalsis (P < 0.001), and more obvious IMVPs, irregular microsurface patterns and DLs (P < 0.05) than in the LGIN and HGIN tissues. The disease-free survival rates at 2, 5, and 8 years after ESD were 95.0%, 90.1%, and 86.9%, respectively. Undifferentiated lesions (HR 5.066), white moss (HR 7.187), incomplete resection (HR 3.658), and multiple primary cancers (HR 2.462) were significantly associated with poor prognosis.

CONCLUSION

Differentiations of gastric mucosal tumors have different epidemiological and endoscopic characteristics, which are closely related to the safety and efficacy of ESD.

Keywords: Gastric mucosal epithelial neoplasia; Differentiated early gastric cancer; Undifferentiated early gastric cancer; Endoscopic submucosal dissection; Long-term outcomes

Core Tip: Endoscopic diagnosis and treatment of early gastric cancer is a hot topic in gastroenterology. By analyzing gastric mucosal tumors treated with endoscopic submucosal dissection (ESD) at a high-volume center in Northwest China, this study investigated the differences in characteristics of gastric mucosal tumors with different degrees of differentiation and the predictors of ESD efficacy and safety, providing data support for the further development of endoscopic technology.