Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2021; 9(10): 2192-2204
Published online Apr 6, 2021. doi: 10.12998/wjcc.v9.i10.2192
Factors associated with overall survival in early gastric cancer patients who underwent additional surgery after endoscopic submucosal dissection
Zhi Zheng, Fan-Di Bu, Hao Chen, Jie Yin, Rui Xu, Jun Cai, Jun Zhang, Hong-Wei Yao, Zhong-Tao Zhang
Zhi Zheng, Fan-Di Bu, Hao Chen, Jie Yin, Jun Cai, Jun Zhang, Hong-Wei Yao, Zhong-Tao Zhang, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, China
Rui Xu, Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Zheng Z, Bu FD, and Chen H equally contributed to this work, and carried out the studies and participated in collecting the data; Zheng Z drafted the manuscript; Yin J, Xu R, and Cai J performed the statistical analysis and participated in its design; Zhang J, Yao HW, and Zhang ZT participated in acquisition, analysis, or interpretation of the data and revised the manuscript; all authors read and approved the final manuscript.
Supported by Beijing Municipal Science & Technology Commission, No. D171100006517003; and Beijing Municipal Administration of Hospitals Incubating Program, No. PX2020001.
Institutional review board statement: This study was approved by the Ethics Committee of Beijing Friendship Hospital, Capital Medical University (Approval No. 2018-P2-015-02).
Informed consent statement: Patients were not required to provide informed consent to the study because this was a retrospective study and only analyzed the clinical data of the patients. All patient data were analyzed after anonymization.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Data sharing statement: No additional data are available.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Zhang, MD, Doctor, Professor, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, No. 95 Yongan Road, Xicheng District, Beijing 100050, China. zhangjun5986@ccmu.edu.cn
Received: August 7, 2020
Peer-review started: August 7, 2020
First decision: December 3, 2020
Revised: December 16, 2020
Accepted: January 25, 2021
Article in press: January 25, 2021
Published online: April 6, 2021
Processing time: 235 Days and 5.2 Hours
ARTICLE HIGHLIGHTS
Research background

Controversy exists about the benefit of additional surgery after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC).

Research motivation

Whether patients who do not meet the criteria for curative resection after ESD need further surgery remains largely controversial. Therefore, factors associated with patient prognosis should be identified, which would provide predictive tools for clinical decisions.

Research objectives

This study aimed to assess the risk factors for overall survival (OS) upon additional surgery in patients with EGC who initially underwent ESD, especially the impacts of lymph node metastasis and residual tumor.

Research methods

Patients were retrospectively assessed, evaluating OS as the primary outcome, and lymph node metastasis and residual tumor as secondary outcomes. Logistic regression models and Kaplan-Meier curves were used for further analysis.

Research results

Male sex, T1b invasion, undifferentiated tumor, lymph node metastasis, and residual tumor were independently associated with OS. In the 4-81-mo follow-up period, OS was 77.0 ± 12.1 mo, and the 3-year and 5-year OS rates were 94.1% and 85%, respectively.

Research conclusions

Male sex, T1b invasion, undifferentiated tumor, lymph node metastasis, and residual tumor are independently associated with OS in patients with EGC undergoing additional surgery after ESD.

Research perspectives

Compared with surgery, ESD could be a safe and effective treatment for some EGC patients to some extent. Nevertheless, additional radical surgery must be considered on a case-by-case basis in order to maximize the radical resection of the tumor and improve long-term prognosis.