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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background
Timely intervention in early gastric cancer can improve the 5-year survival rate to more than 90%. Endoscopic submucosal dissection (ESD) is a safe and mature endoscopic treatment method, but its indications, postoperative management strategies and related influencing factors are still under exploration.
Research motivation
The aim of this study was to explore the underlying factors affecting the development of gastric mucosal tumors, the efficacy of ESD and the underlying scientific prevention and treatment strategies after surgery.
Research objectives
The epidemiological, clinical, and endoscopic features and ESD efficacy of gastric mucosal tumors with different degrees of differentiation were analyzed by stratification, and the related risk factors affecting preoperative diagnosis, ESD efficacy and long-term disease-free survival (DFS) were explored.
Research methods
According to the latest Japanese guidelines (sixth edition), 301 patients with gastric mucosal tumors treated with ESD at our center from 2014 to 2021 were enrolled, and followed up by endoscopy and chest and abdominal computed tomography at 3, 6 and 12 months after surgery for monitoring, and the data were retrospectively analyzed.
Research results
The greater the degree of differentiation of the lesion is, the more likely the lesion is to develop into depression, the deeper the infiltration depth, the more obvious the magnified endoscopy with narrow-band imaging (ME + NBI) abnormality, and the more postoperative complications and adverse outcomes there are. The overall survival rates at 2, 5 and 8 years were 99.0%, 97.7% and 95.7%, respectively, and the DFS rates were 95.0%, 90.1% and 86.9%, respectively. Undifferentiated lesions (HR 5.066), coating with white moss (HR 7.187), incomplete resection (HR 3.658), and multiple primary cancers (HR 2.462) were risk factors for poor prognosis.
Research conclusions
Before ESD, it is necessary to strictly screen lesions that meet the indications and be aware of the risk factors that affect the efficacy of ESD. Patients with high-risk factors should be followed up more closely after surgery to identify any recurrence and metastasis in a timely manner. After noncurative resection, additional surgical resection and lymph node dissection should be performed according to the patient’s condition.
Research perspectives
A large-scale, multicenter retrospective study in Northwest China is needed to increase the sample size and the number of positive outcomes, and further exploration of treatment options for patients with noncurative resections is necessary.
