Risk factors for metachronous gastric carcinoma development after endoscopic resection of gastric dysplasia: Retrospective, single-center study

Table 1 Baseline characteristics of patients (n = 641)

Patient	n (%)
Sex
Male	454 (70.8)
Female	187 (29.2)
Age, years (mean ± SD)	31–88 (63.5 ± 9.7)
< 60	207 (32.3)
≥ 60	434 (67.7)
Number of resected lesions
Single	618 (96.4)
Double	20 (3.1)
Triple	3 (0.5)
Atrophic gastritis
Closed	570 (88.9)
Open	71 (11.1)
Intestinal metaplasia
Absence	402 (62.7)
Presence	239 (37.3)
Site of initial lesion
Upper	12 (1.9)
Mid	219 (34.2)
Lower	410 (63.9)
Size of initial lesion, cm
< 3.0	442 (69.0)
≥ 3.0	199 (31.0)
Morphology of initial lesion
Elevated	431 (67.3)
Flat	131 (20.4)
Depressed	79 (12.3)
Dysplasia grade of initial lesion
Low	538 (84.0)
High	103 (16.0)
Helicobacter Pylori infection
Positive	500 (78)
Negative	141 (22)

Table 2 Baseline analysis of patients with gastric dysplasia n (%)

	Control group	Synchronous group	Metachronous group	P value
	(n = 488)	(n = 80)	(n = 91)
Male gender	328 (67.2)	61 (76.2)	76 (83.5)	0.003
mean ± SD, yr	64.03 ± 9.86)	61.66 ± 8.18	62.73 ± 9.96	0.131
Dysplasia				0.121
Low grade	417 (85.5)	66 (82.5)	70 (76.9)
High grade	71 (14.5)	14 (17.5)	21 (23.1)
En bloc resection	179 (36.7)	29 (36.2)	32 (35.2)	0.973
Intestinal metaplasia	155 (31.8)	42 (52.5)	45 (49.5)	0.000
Atrophy				0.013
Closed	445 (91.2)	67 (83.8)	75 (82.4)
Open	43 (8.8)	13 (16.2)	16 (17.6)
Resection method				0.439
EMR	359 (73.6)	64 (80.0)	66 (72.5)
ESD	129 (26.4)	16 (20.0)	25 (27.5)
Endoscopic findings				0.483
Elevated	326 (66.8)	54 (67.5)	64 (70.3)
Flat	96 (19.7)	20 (25.0)	18 (19.8)
Depressed	66 (13.5)	6 (7.5)	9 (9.9)
Location				0.144
Lower	324 (66.4)	46 (57.5)	52 (57.1)
Mid	156 (32.0)	31 (38.8)	38 (41.8)
Upper	8 (1.6)	3 (3.8)	1 (1.1)
mean ± SD, cm	2.12 ± 0.79	2.53 ± 1.10	2.68 ±1.31	0.065
Helicobacter Pylori infection	385 (78.9)	67 (83.8)	66 (72.5)	0.208

Table 3 Analysis of clinical factors associated with occurrence of synchronous lesions n (%)

	Control group	Synchronous group	Univariate analysis	Multivariate analysis
	(n = 488)	(n = 80)	P value	OR	95%CI	P value
Sex			0.120
Male	328 (67.2)	61 (76.2)
Female	160 (32.8)	19 (23.8)
Age			0.000			0.000
≥ 60	343 (70.3)	40 (50.0)		0.395	0.241-0.646
< 60	145 (29.7)	40 (50.0)		1.000
Dysplasia			0.500
Low grade	417 (85.5)	66 (82.5)
High grade	71 (14.5)	14 (17.5)
En bloc resection	179 (37.7)	29 (36.2)	0.941
Intestinal metaplasia	155 (31.8)	42 (52.5)	0.001	2.260	1.377-3.707	0.001
Atrophy			0.044			0.086
Closed	445 (91.2)	67 (83.8)		1.000
Open	43 (8.8)	13 (16.2)		1.860	0.915-3.783
Resection method			0.269
EMR	359 (73.6)	64 (80.0)
ESD	129 (26.4)	16 (20.0)
Endoscopic findings			0.231
Elevated	326 (66.8)	54 (67.5)
Flat	96 (19.7)	20 (25.0)
Depressed	66 (13.5)	6 (7.5)
Location			0.185
Lower	324 (66.4)	46 (57.5)
Mid	156 (32.0)	31 (38.8)
Upper	8 (1.6)	3 (3.8)
Size			0.295
≤ 3	334 (68.4)	60 (75.0)
> 3	154 (31.6)	20 (25.0)
Helicobacter Pylori infection	385 (78.9)	67 (83.8)	0.371

Table 4 Analysis of clinical factors associated with occurrence of metachronous lesions n (%)

	Control group	Metachronous group	Univariate analysis	Multivariate analysis
	(n = 488)	(n = 91)	P value	OR	95%CI	P value
Sex			0.002			0.005
Male	328 (67.2)	76 (83.5)		2.314	1.281-4.179
Female	160 (32.8)	15 (16.5)		1.000
Age			0.174
≥ 60	343 (70.3)	70 (76.9)
< 60	145 (29.7)	21 (23.1)
Dysplasia			0.059
Low grade	417 (85.5)	70 (76.9)
High grade	71 (14.5)	21 (23.1)
En bloc resection	179 (37.7)	32 (35.2)	0.813
Intestinal metaplasia	155 (31.8)	45 (49.5)	0.002	1.915	1.203-3.049	0.006
Atrophy			0.022			0.103
Closed	445 (91.2)	75 (82.4)		1.000
Open	43 (8.8)	16 (17.6)		1.708	0.897-3.252
Resection method			0.897
EMR	359 (73.6)	66 (72.5)
ESD	129 (26.4)	25 (27.5)
Endoscopic findings			0.665
Elevated	326 (66.8)	64 (70.3)
Flat	96 (19.7)	18 (19.8)
Depressed	66 (13.5)	9 (9.9)
Location			0.172
Lower	324 (66.4)	52 (57.1)
Mid	156 (32.0)	38 (41.8)
Upper	8 (1.6)	1 (1.1)
Size			0.394
≤ 3	334 (68.4)	58 (63.7)
> 3	154 (31.6)	33 (36.3)
Helicobacter Pylori infection	385 (78.9)	66 (72.5)	0.210

Table 5 Analysis of risk factors associated with occurrence of metachronous carcinoma n (%)

	Control group(n = 488)	Metachronous carcinoma group (n = 27)	Univariate analysisP value	Multivariate analysis
				OR	95%CI	P value
Sex			0.005			0.027
Male	328 (67.2)	25 (92.6)		5.238	1.211-22.661
Female	160 (32.8)	2 (7.4)		1.000
Age			0.671
≥ 60	343 (70.3)	18 (66.7)
< 60	145 (29.7)	9 (33.3)
Dysplasia			0.024			0.023
Low grade	417 (85.5)	18 (66.7)		1.000
High grade	71 (14.5)	9 (33.3)		2.741	1.148-6.546
En bloc resection	179 (37.7)	9 (33.3)	0.839
Intestinal metaplasia	155 (31.8)	9 (33.3)	0.005	2.647	1.165-6.012	0.020
Atrophy			0.010			0.065
Closed	445 (91.2)	20 (74.1)		1.000
Open	43 (8.8)	7 (25.9)		2.492	0.946-6.569
Resection method			0.503
EMR	359 (73.6)	18 (66.7)
ESD	129 (26.4)	9 (33.3)
Endoscopic findings			0.546
Elevated	326 (66.8)	21 (77.8)
Flat	96 (19.7)	3 (11.1)
Depressed	66 (13.5)	3 (11.1)
Location			1.000
Lower	324 (66.4)	17 (63.0)
Mid	156 (32.0)	9 (33.3)
Upper	8 (1.6)	0 (0.0)
Size			0.532
≤ 3	334 (68.4)	17 (63.0)
> 3	154 (31.6)	10 (37.0)
Helicobacter Pylori infection	385 (78.9)	20 (74.1)	0.629