Characteristics of early gastric tumors with different differentiation and predictors of long-term outcomes after endoscopic submucosal dissection

doi:10.3748/wjg.v30.i14.1990

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Apr 14, 2024; 30(14): 1990-2005
Published online Apr 14, 2024. doi: 10.3748/wjg.v30.i14.1990

Table 1 Clinical characteristics of gastric mucosal tumors with different degrees of differentiation, n (%)

	LGIN (n = 96)	HGIN (n = 100)	Differentiated-type (n = 89)	Undifferentiated-type (n = 16)	P value
Gender					0.013
Male	61 (63.5)^a	76 (76.0)^a^,^b	73 (82.0)^b	9 (56.3)^a^,^b
Female	35 (36.5)^a	24 (24.0)^a^,^b	16 (18.0)^b	7 (43.8)^a^,^b
Age (yr) (range)	57 (55-59)^a	63 (61-65)^b	63 (61-65)^b	64 (59-68)^a^,^b	< 0.001
Comorbidity
Diabetes	6 (6.3)	15 (15.0)	9 (10.1)	0 (0.0)	0.108
Hypertension	17 (17.7)	31 (31.0)	19 (21.3)	4 (25.0)	0.161
Cardiovascular disease	5 (5.2)	8 (8.0)	9 (10.1)	2 (12.5)	0.572
Liver cirrhosis	5 (5.2)	1 (1.0)	2 (2.2)	0 (0.0)	0.265
Chronic pulmonary disease	2 (2.1)	6 (6.0)	1 (1.1)	0 (0.0)	0.175
Reflux esophagitis	15 (15.6)	12 (12.0)	11 (12.4)	3 (18.8)	0.794
Barrett’s esophagus	4 (4.2)	2 (2.0)	1 (1.1)	0 (0.0)	0.489
Atrophic gastritis	72 (75.0)^a	93 (93.0)^b	84 (94.4)^b	13 (81.3)^a^,^b	< 0.001
Previous gastric cancer	1 (1.0)	0 (0.0)	2 (2.2)	0 (0.0)	0.461
Smoking history	26 (27.1)^a	49 (49.0)^b	45 (50.6)^b	6 (37.5)^a^,^b	0.004
Drinking history	24 (25.0)	31 (31.0)	24 (27.0)	3 (18.8)	0.673
Family history	15 (15.6)	11 (11.0)	19 (21.3)	0 (0.0)	0.074

^aP < 0.05.

^bP < 0.05.

Data in the same row are superscripted with the same letter or have no superscript to indicate a non-significant difference (P > 0.05). Different letters to indicate a significant difference (P < 0.05). LGIN: Low-grade intraepithelial neoplasia; HGIN: High-grade intraepithelial neoplasia.

Table 2 Pathological characteristics of gastric mucosal tumors with different degrees of differentiation, n (%)

	LGIN (n = 96)	HGIN (n = 100)	Differentiated-type (n = 89)	Undifferentiated-type (n = 16)	P value
Size (cm) (range)	2.7 (2.2-3.7)^a	3.2 (2.4-3.7)^a^,^b	3.7 (2.7-4.2)^b	3.5 (2.8-4.6)^b	0.001
Location					0.006
Top 1/3	19 (19.8)	30 (30.0)	33 (37.1)	2 (12.5)
Medium 1/3	10 (10.4)	22 (22.0)	13 (14.6)	5 (31.3)
Lower 1/3	67 (69.8)^a	48 (48.0)^b	43 (48.3)^b	9 (56.3)^a^,^b
Paris classification					< 0.001
0-I	24 (25.0)^a	3 (3.0)^b	3 (3.4)^b	2 (12.5)^a^,^b
0-IIa	19 (19.8)	14 (14.0)	11 (12.4)	0 (0.0)
0-IIb	9 (9.4)	11 (11.0)	9 (10.1)	0 (0.0)
0-IIc	20 (20.8)^a	39 (39.0)^b	39 (43.8)^b	8 (50.0)^a^,^b
0-III	1 (1.0)	1 (1.0)	1 (1.1)	0 (0.0)
0-IIa+ IIc	23 (24.0)	32 (32.0)	26 (29.2)	6 (37.5)
Invasion depth					< 0.001
M1M2	96 (100.0)^a	100 (100.0)^a	43 (48.3)^b	5 (31.3)^b
M3	0 (0.0)^a	0 (0.0)^a	37 (41.6)^b	6 (37.5)^b
SM1	0 (0.0)^a^,^b	0 (0.0)^b	6 (6.7)^a^,^c	2 (12.5)^c
SM2	0 (0.0)^a	0 (0.0)^a	3 (3.4)^a^,^b	3 (18.8)^b
Presence of H. pylori	37 (48.7)	38 (52.8)	32 (56.1)	4 (40.0)	0.727
Presence of ulceration	6 (6.3)	6 (6.0)	7 (7.9)	4 (25.0)	0.058

^aP < 0.05.

^bP < 0.05.

^cP < 0.05.

Table 3 The white light endoscopic manifestations of gastric mucosal tumors with different degrees of differentiation, n (%)

	LGIN (n = 96)	HGIN (n = 100)	Differentiated-type (n = 89)	Undifferentiated-type (n = 16)	P value
Nodularity	65 (67.7)	65 (65.0)	60 (67.4)	11 (68.8)	0.974
Redness	51 (53.1)	50 (50.0)	60 (67.4)	7 (43.8)	0.059
Whiteness	7 (7.3)	5 (5.0)	2 (2.2)	0 (0.0)	0.324
White moss	10 (10.4)	14 (14.0)	15 (16.9)	2 (12.5)	0.646
Spontaneous bleeding	3 (3.1)^a	11 (11.0)^a^,^b	18 (20.2)^b	0 (0.0)^a^,^b	0.001
Abnormal fold	3 (3.1)^a	1 (1.0)^a	6 (6.7)^a^,^b	4 (25.0)^b	< 0.001
Poor peristalsis	2 (2.1)^a^,^b	1 (1.0)^b	9 (10.1)^a^,^c	3 (18.8)^c	< 0.001

^aP < 0.05.

^bP < 0.05.

^cP < 0.05.

Table 4 Magnified endoscopy with narrow-band imaging manifestations of gastric mucosal tumors with different degrees of differentiation, n (%)

	LGIN (n = 96)	HGIN (n = 100)	Differentiated-type (n = 89)	Undifferentiated-type (n = 16)	P value
IMVP	25 (38.5)^a	51 (66.2)^b	49 (77.8)^b	11 (100.0)^b	< 0.001
IMSP	32 (49.2)^a	46 (59.7)^a^,^b	44 (69.8)^a^,^b	10 (90.9)^b	0.018
DL	46 (63.0)^a	69 (86.3)^b	58 (90.6)^b	11 (91.7)^b	< 0.001

^aP < 0.05.

^bP < 0.05.

Table 5 Endoscopic submucosal dissection efficacy and safety of gastric mucosal tumors with different degrees of differentiation, n (%)

	LGIN (n = 96)	HGIN (n = 100)	Differentiated-type (n = 89)	Undifferentiated-type (n = 16)	P value
Absolute indication	91 (94.8)^a^,^b	97 (97.0)^b	77 (86.5)^a	2 (12.5)^c	< 0.001
En bloc resection	93 (96.9)	98 (98.0)	88 (98.9)	16 (100.0)	0.729
Complete resection	88 (91.7)	90 (90.0)	79 (88.8)	13 (81.3)	0.630
Curative resection	83 (86.5)^a	87 (87.0)^a	70 (78.7)^a	2 (12.5)^b	< 0.001
Complication	5 (5.2)^a	5 (5.0)^a	3 (3.4)^a	4 (25.0)^b	0.007
Bleeding	3 (3.1)^a^,^b	1 (1.0)^b	2 (2.2)^b	3 (18.8)^a	0.002
Perforation	2 (2.1)	4 (4.0)	2 (2.2)	1 (6.3)	0.710
Stenosis	0 (0.0)^a	0 (0.0)^a	0 (0.0)^a	1 (6.3)^b	< 0.001

^aP < 0.05.

^bP < 0.05.

^cP < 0.05.

Table 6 Follow-up results of gastric mucosal tumors with different degrees of differentiation, n (%)

	LGIN (n = 96)	HGIN (n = 100)	Differentiated-type (n = 89)	Undifferentiated-type (n = 16)	P value
BMI (range)	23.87 (23.19-24.54)^a	23.09 (22.41-23.77)^a^,^b	22.37 (21.71-23.02)^b	21.44 (20.08-22.79)^b	0.003
Adverse outcome	8 (8.3)^a	6 (6.0)^a	7 (7.9)^a	6 (37.5)^b	< 0.001
Recurrence	5 (5.2)	6 (6.0)	6 (6.7)	2 (12.5)	0.734
Metastasis	3 (3.1)^a^,^b	0 (0.0)^b	2 (2.2)^b	3 (18.8)^a	< 0.001
Multiple primary cancer	24 (25.0)	15 (15.0)	15 (16.9)	4 (25.0)	0.276

^aP < 0.05.

^bP < 0.05.

Table 7 Multivariate analysis of time-related factors of adverse outcomes such as recurrence, metastasis and death

Variable	Category	P value	Hazard ratio	95%CI
Differentiation degree	Undifferentiated-type	0.004	5.066	1.688-15.200
Differentiation degree	LGIN	0.004	1	1.688-15.200
White moss	Yes	< 0.001	7.187	3.122-16.546
White moss	No	< 0.001	1	3.122-16.546
Complete resection	No	0.012	3.658	1.337-10.010
Complete resection	Yes	0.012	1	1.337-10.010
Multiple primary cancer	Yes	0.030	2.462	1.090-5.562
Multiple primary cancer	No	0.030	1	1.090-5.562

LGIN: Low-grade intraepithelial neoplasia.

Table 8 Multivariate analysis of factors associated with incomplete resection

Variable	Category	P value	Odds ratio	95%CI
Invasion depth	M1M2	0.004	11.200	2.120-59.163
	M3	0.032	7.600	1.192-48.437
	SM2	-	1	-

Table 9 Multivariate analysis of factors associated with noncurative resection

Variable	Category	P value	Odds ratio	95%CI
Peristaltic condition	Poor	0.009	0.185	0.052-0.653
Peristaltic condition	Normal	0.009	1	0.052-0.653
Microsurface pattern	Irregular	0.043	0.410	0.173-0.972
Microsurface pattern	Regular	0.043	1	0.173-0.972
Ulceration	Yes	< 0.001	0.073	0.026-0.207
Ulceration	No	< 0.001	1	0.026-0.207

Table 10 Multivariate analysis of complications related factors

Variable	Categor	P value	Odds ratio	95%CI
Histologic type	Signet ring cell (sig)	0.032	32.627	1.357-784.415
	Mucinous (muc)	0.006	49.855	3.051-814.724
	LGIN	-	1	-
Paris classification	0-III	0.020	30.406	1.695-545.565
Paris classification	0-I	0.020	1	1.695-545.565

LGIN: Low-grade intraepithelial neoplasia.

Table 11 Multivariate analysis of factors related to postoperative pathological degradation

Variable	Category	P value	Odds ratio	95%CI
Location	Lower 1/3	0.037	2.399	1.055-5.455
Location	Top 1/3	0.037	1	1.055-5.455
Barrett’s esophagus	Yes	0.026	7.805	1.277-47.689
Barrett’s esophagus	No	0.026	1	1.277-47.689

Table 12 Multivariate analysis of factors related to postoperative pathological upgrading

Variable	P value	Odds ratio	95%CI
BMI	0.022	0.906	0.833-0.986

BMI: Body mass index.

Citation: Zhu HY, Wu J, Zhang YM, Li FL, Yang J, Qin B, Jiang J, Zhu N, Chen MY, Zou BC. Characteristics of early gastric tumors with different differentiation and predictors of long-term outcomes after endoscopic submucosal dissection. World J Gastroenterol 2024; 30(14): 1990-2005
URL: https://www.wjgnet.com/1007-9327/full/v30/i14/1990.htm
DOI: https://dx.doi.org/10.3748/wjg.v30.i14.1990