Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2022; 14(9): 1823-1832
Published online Sep 15, 2022. doi: 10.4251/wjgo.v14.i9.1823
Construction and analysis of an ulcer risk prediction model after endoscopic submucosal dissection for early gastric cancer
San-Dong Gong, Huan Li, Yi-Bin Xie, Xiao-Hui Wang
San-Dong Gong, Xiao-Hui Wang, Department of Gastroenterology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, Hainan Province, China
Huan Li, Xiao-Hui Wang, Department of Gastroenterology, Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
Yi-Bin Xie, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Gong SD and Wang XH designed the study; Gong SD and Li H performed the research; Gong SD, Li H, Xie YB and Wang XH analyzed the date; Gong SD wrote the paper; Wang XH revised the manuscript for final submission; Gong SD and Li H contributed equally to this study; Xie YB and Wang XH are the corresponding authors; and all authors read and approved the final version.
Supported by The CAMS Initiative for Innovative Medicine, No. 2016-I2M-1-007.
Institutional review board statement: The study was reviewed and approved by the National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
Informed consent statement: Written informed consent was exempted, because all patients had already signed the informed consents before treatment according to the institutional guideline, and all the information used in present study were obtained the raw data documented in the database.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are declared to be shared.
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: Xiao-Hui Wang, MD, Associate Chief Physician, Doctor, Department of Gastroenterology, Sixth Medical Center of Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100048, China. wangxiaohui9727@sohu.com
Received: April 19, 2022
Peer-review started: April 19, 2022
First decision: May 11, 2022
Revised: May 14, 2022
Accepted: August 14, 2022
Article in press: August 14, 2022
Published online: September 15, 2022
Abstract
BACKGROUND

Endoscopic submucosal dissection (ESD) has been widely used in the treatment of early gastric cancer (EGC). A personalized and effective prediction method for ESD with EGC is urgently needed.

AIM

To construct a risk prediction model for ulcers after ESD for EGC based on LASSO regression.

METHODS

A total of 196 patients with EGC who received ESD treatment were prospectively selected as the research subjects and followed up for one month. They were divided into an ulcer group and a non-ulcer group according to whether ulcers occurred. The general data, pathology, and endoscopic characteristics of the groups were compared, and the best risk predictor subsets were screened by LASSO regression and tenfold cross-validation. Multivariate logistic regression was applied to analyze the risk factors for ulcers after ESD in patients with EGC. A receiver operating characteristic (ROC) curve was used to estimate the predictive model performance.

RESULTS

One month after the operation, no patient was lost to follow-up. The incidence of ulcers was 20.41% (40/196) (ulcer group), and the incidence of no ulcers was 79.59% (156/196) (non-ulcer group). There were statistically significant differences in the course of disease, Helicobacter pylori infection history, smoking history, tumor number, clopidogrel medication history, lesion diameter, infiltration depth, convergent folds, and mucosal discoloration between the groups. Gray's medication history, lesion diameter, convergent folds, and mucosal discoloration, which were the 4 nonzero regression coefficients, were screened by LASSO regression analysis. Further multivariate logistic analysis showed that lesion diameter [Odds ratios (OR) = 30.490, 95%CI: 8.584-108.294], convergent folds (OR = 3.860, 95%CI: 1.060-14.055), mucosal discoloration (OR = 3.191, 95%CI: 1.016-10.021), and history of clopidogrel (OR = 3.554, 95%CI: 1.009-12.515) were independent risk factors for ulcers after ESD in patients with EGC (P < 0.05). The ROC curve showed that the area under the curve of the risk prediction model for ulcers after ESD in patients with EGC was 0.944 (95%CI: 0.902-0.972).

CONCLUSION

Clopidogrel medication history, lesion diameter, convergent folds, and mucosal discoloration can predict the occurrence of ulcers after ESD in patients with EGC.

Keywords: Endoscopic submucosal dissection, Early gastric cancer, Endoscopic features, Ulcer, Model

Core Tip: In recent years, with the development of endoscopic techniques, endoscopic submucosal dissection (ESD) has been widely used in the treatment of early gastric cancer (EGC). Nevertheless, it is difficult to determine the presence of histological ulcers before ESD, and the presence of ulcers in EGCs is closely related to their depth of invasion and lymphatic invasion. In this study, we aimed to build a personalized prediction model for EGC patients after ESD.