• eCuraB
• endoscopic submucosal dissection
• gastric cancer
• metastasis
• recurrence

• Field cancerization
• Gastric cancer
• Immune
• Sequencing
• Transcriptome
• Whole exome

• Adenocarcinoma
• Endoscopic submucosal dissection
• Stomach neoplasm
• Survival
• Treatment outcome

• Humans
• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Stomach Neoplasms/mortality
• Male
• Female
• Adenocarcinoma/surgery
• Adenocarcinoma/pathology
• Adenocarcinoma/mortality
• Aged
• Middle Aged
• Endoscopic Mucosal Resection/methods
• Treatment Outcome
• Adult
• Aged, 80 and over
• Retrospective Studies

• Endoscopic resection
• Gastric cancer
• Metachronous neoplasms
• Surveillance

• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Humans
• Neoplasms, Second Primary/pathology
• Neoplasms, Second Primary/surgery
• Gastroscopy/methods
• Early Detection of Cancer/methods
• Time Factors
• Gastric Mucosa/pathology
• Gastric Mucosa/surgery
• Endoscopic Mucosal Resection/methods
• Gastrectomy/methods
• Gastrectomy/adverse effects
• Risk Factors

• RNA sequencing
• biomarkers
• endoscopic resection
• gastric cancer
• whole exome sequencing

• Humans
• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Stomach Neoplasms/genetics
• Male
• Female
• Biomarkers, Tumor/genetics
• Middle Aged
• Aged
• Neoplasms, Second Primary/genetics
• Neoplasms, Second Primary/pathology
• Endoscopic Mucosal Resection
• CDC2 Protein Kinase/genetics
• CDC2 Protein Kinase/metabolism
• Gastric Mucosa/pathology
• Gastric Mucosa/surgery
• Gastric Mucosa/microbiology
• Gastric Mucosa/metabolism
• Helicobacter Infections/complications
• Helicobacter Infections/genetics
• Gastroscopy
• Gene Expression Regulation, Neoplastic
• Metaplasia/genetics
• Metaplasia/pathology
• Helicobacter pylori/isolation & purification
• Case-Control Studies

• #NRF-2022R1A2B5B01001430 The National Research Foundation of Korea
• #NRF-2022R1A4A2000827 The National Research Foundation of Korea
• KCHUGR - 202002001 The Korean College of Helicobacter and Upper Gastrointestinal Research Foundation
• KCHUGR-202102001 The Korean College of Helicobacter and Upper Gastrointestinal Research Foundation
• #03-2020-0370 SNUH research fund
• #03-2022-0140 SNUH research fund
• NRF-2021R1F1A1045550 The Basic Science Research Program through the National Research Foundation of Korea (NRF)
• 800-20220338 The Seoul National University College of Medicine Research foundation

• endoscopic submucosal dissection
• endoscopy
• metachronous gastric cancer
• propensity score matching
• stomach neoplasm

• Humans
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/surgery
• Stomach Neoplasms/epidemiology
• Endoscopic Mucosal Resection
• Retrospective Studies
• Gastroscopy
• Treatment Outcome
• Gastric Mucosa/surgery

• Early gastric cancer
• Endoscopic submucosal dissection
• Postoperative
• Prediction
• Recurrence

• differentiated gastric adenocarcinoma
• early gastric cancer
• lymph node metastasis
• submucosal dissection
• tumor budding

• Male
• Humans
• Aged, 80 and over
• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Lymph Node Excision/methods
• Lymphatic Metastasis/pathology
• Gastrectomy/methods
• Gastric Mucosa/pathology
• Adenocarcinoma/surgery
• Adenocarcinoma/pathology
• Risk Factors
• Retrospective Studies
• Neoplasm Invasiveness/pathology

• 5-2023-B0001-00023 The Catholic Medical Center Research Foundation made in the program year of 2023

• Humans
• Male
• Female
• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Gastroscopy/methods
• Endoscopic Mucosal Resection/adverse effects
• Endoscopic Mucosal Resection/methods
• Retrospective Studies
• Gastric Mucosa/surgery
• Gastric Mucosa/pathology
• Treatment Outcome

• Associated factors
• Early gastric cancer
• Endoscopic mucosal dissection
• Heterochronic gastric cancer
• Statistical analysis

• Attitudes
• Endoscopic submucosal dissection
• Gastric cancer
• Knowledge
• Practice
• Recurrence

• Cancer screening
• Endoscopic curability C2
• Endoscopic submucosal dissection
• Gastric cancers missed
• Metachronous gastric cancer

• Humans
• Follow-Up Studies
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Endoscopic Mucosal Resection
• Retrospective Studies
• Gastric Mucosa/surgery
• Gastric Mucosa/pathology
• Treatment Outcome

• Humans
• Stomach Neoplasms/surgery
• Pylorus/surgery
• Endoscopic Mucosal Resection/adverse effects
• Retrospective Studies
• Gastrectomy
• Carcinoma
• Treatment Outcome
• Gastric Mucosa/surgery

• Endoscopic submucosal dissection
• Endoscopy
• Stomach neoplasms

Endoscopic submucosal dissection (ESD) has been accepted as the standard treatment for the appropriate indication of early gastric cancer (EGC). Determining the risk of lymph node metastasis (LNM) is critical for the following treatment selection after ESD. This study aimed to develop a predictive model to quantify the probability of LNM in EGC to help minimize the invasive procedures.

A total of 952 patients with EGC who underwent radical gastrectomy were retrospectively reviewed. LASSO regression was used to help screen the potential risk factors. Multivariate logistic regression was used to establish a predictive nomogram, which was subjected to discrimination and calibration evaluation, bootstrapping internal validation, and decision curve analysis.

Results of multivariate analyses revealed that gender, fecal occult blood test, CEA, CA19-9, histologic differentiation grade, lymphovascular invasion, depth of infiltration, and Ki67 labeling index were independent prognostic factors for LNM. The nomogram had good discriminatory performance, with a concordance index of 0.816 (95% CI 0.781–0.853). The validation dataset yielded a corrected concordance index of 0.805 (95% CI 0.770–0.842). High agreements between ideal curves and calibration curves were observed.

The nomogram is clinically useful for predicting LNM after ESD in EGC, which is beneficial to identifying patients who are at low risk for LNM and would benefit from avoiding an unnecessary gastrectomy.

• National Natural Science Foundation of China

• mesothelial–mesenchymal transition
• peritoneal mesothelial cells
• peritoneal metastatic cancer

• 20JR10RA372 Natural Science Foundation of Gansu Province
• GSWSKY-2019-03 Health Industry Research Project of Gansu Province
• 19SYPYB-10 National scientific research project support program of Gansu Provincial Hospital
• 2020GSZDSYS02 Open fund project of Gansu Key Laboratory of Molecular Diagnosis and Precision Therapy of Surgical Oncology
• NLDTG2020020 Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences

• Endoscopic submucosal dissection
• Stomach neoplasms
• Surgery
• Systematic review
• Undifferentiated histology

• Endoscopic Mucosal Resection/adverse effects
• Gastric Mucosa/surgery
• Humans
• Prospective Studies
• Retrospective Studies
• Stomach Neoplasms/surgery
• Treatment Outcome

• Korea Health Industry Development Institute

Countries differ in their treatment expertise and research results regarding gastric cancer; hence, treatment guidelines are diverse based on evidence and medical situations. A comprehensive and comparative review of each country’s guidelines is imperative to understand the similarities and differences among countries. We reviewed and compared five gastric cancer treatment guidelines in terms of endoscopic, surgical, perioperative, and palliative systemic treatment based on evidence levels and recommendation grades, as well as the postoperative follow-up strategies for each guideline. The Korean, Chinese, and European guidelines provided evidence and grading of the recommendations. The United States guidelines suggested categories for evidence and consensus. The Japanese guidelines suggested evidence and recommendations only for systemic treatment. The Korean and Japanese guidelines described endoscopic treatment, surgery, and lymphadenectomy in detail. The Chinese, United States, and European guidelines more intensively considered perioperative chemotherapy. In particular, the indications for chemotherapy and the regimens recommended by each guideline differed slightly. Considering their medical situations, each guideline had some diversity in terms of adopting evidence, which resulted in heterogeneous recommendations. This review will help medical personnel to comprehensively understand the diversity in gastric cancer treatment guidelines for each country in terms of evidence and recommendations.

It is uncertain whether additional endoscopic treatment may be chosen over surgery in patients with positive lateral margins (pLMs) as the only non-curative factor after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). We aimed to compare the long-term outcomes of additional endoscopic treatments in such patients with those of surgery and elucidate the clinicopathological factors that could influence the treatment selection.

A total of 99 patients with 101 EGC lesions undergoing additional treatment after non-curative ESD with pLMs as the only non-curative factor were analyzed. Among them, 25 (27 lesions) underwent ESD, 29 (29 lesions) underwent argon plasma coagulation (APC), and 45 (45 lesions) underwent surgery. Clinicopathological characteristics and long-term outcomes were compared.

Residual tumor was found in 73.6% of cases. The presence of multiple pLMs was associated with higher risk of residual tumor (p=0.046). During a median follow-up of 58.9 months, recurrent or residual lesions after additional ESD and APC were found in 4% (1/25) and 6.8% (2/29) of patients, respectively. However, all were completely cured with surgery or repeated ESD. There were no extragastric recurrences after additional endoscopic treatment. Lymph node metastasis was identified after additional surgery in one (2.2%) patient with an EGC showing histological heterogeneity.

Given the favorable long-term outcomes, additional ESD or APC may be an acceptable choice for patients with pLMs as the only non-curative factor after ESD for EGC. However, clincopathological characteristics such as multiple pLMs and histological heterogeneity should be considered in the treatment selection.

• Endoscopic mucosal resection
• Margins of excision
• Outcomes
• Stomach neoplasms

• Endoscopic submucosal dissection
• Metachronous gastric cancer
• Undifferentiated-type early gastric cancer

• Endoscopic Mucosal Resection/adverse effects
• Endoscopy, Gastrointestinal
• Gastric Mucosa
• Humans
• Incidence
• Japan/epidemiology
• Medical Oncology
• Retrospective Studies
• Stomach Neoplasms/surgery
• Treatment Outcome

• Gastric neoplasm
• endoscopic resection
• surveillance

To obtain the optimal treatment effect of endoscopic resection (ER) in early gastric carcinoma (EGC), a well-established indication for post-ER surgery is needed. In addition, accurate prediction of lymph node metastasis (LNM) is necessary to achieve this goal. Here, we present modified tumor budding (mTB), which excludes signet ring cells from conventional tumor budding (TB) as a novel predictor for LNM. Conventional TB and mTB were the most predictive independent factors for LNM. Furthermore, mTB was superior to TB in predicting LNM (p = 0.0004–0.0008). In conclusion, mTB significantly enhanced the predictive power of LNM, which could be a novel indicator for determining post-ER surgery.

Endoscopic resection (ER) is a minimally invasive treatment for early gastric cancer (EGC) with a low risk of lymph node metastasis (LNM). Recently, tumor budding (TB) has emerged as a potential predictor of LNM in EGC. We assessed the clinical significance of modified TB (mTB) that excludes the signet ring cell component and compared several TB assessment methods. Two hundred and eighty-nine patients with EGC at Uijeongbu St. Mary’s Hospital from 2010 to 2021 were enrolled. In univariate analysis, age, size, depth of invasion, tumor type, histologic type, Lauren classification, lymphatic invasion, venous invasion, poorly differentiated carcinoma (“not otherwise specified” predominant), and TB were significantly associated with LNM. Multivariate regression analysis showed that mTB (difference area under the curve [dAUC] = 0.085 and 0.087) was superior to TB (dAUC = 0.054 and 0.057) in predicting LNM. In addition, total TB counts on representative slide sections (dAUC = 0.087 and 0.057) in assessing TB and mTB and the ITBCC method (dAUC = 0.085) in mTB were superior to the presence or absence method (dAUC = 0.042 and 0.029). The mTB significantly increases LNM prediction ability, which can provide important information for patients with EGC.

• assessment method
• early gastric cancer
• endoscopic resection
• lymph node metastasis
• modified tumor budding
• surgical indication
• tumor budding

• Early gastric cancer (EGC)
• Endoscopic mucosal resection (EMR)
• Endoscopic submucosal dissection (ESD)
• Stomach

• Early colorectal cancer
• Early gastric cancer
• Endoscopic resection
• Guideline
• Superficial esophageal squamous cell carcinoma

The development of endoscopic treatment technology has further promoted the minimally invasive treatment of early gastric cancer (EGC). Endoscopic treatment has achieved better therapeutic effects in terms of safety and prognosis and is the preferred treatment method for patients who meet the indications for endoscopic treatment. However, the consequent problem is that some patients receiving endoscopic treatment may undergo non-curative resection, and the principle of follow-up management for non-curative resection patients deserves further attention. In addition, there are still debates on how to improve the accuracy of clinical staging, select a reasonable treatment method for patients who meet the expanded indications for endoscopic treatment, manage patients with positive endoscopic surgical margins, conduct research on function-preserving surgery, and manage the treatment of EGC under the current situation in China. Consequently, we aim to review current indications for endoscopic submucosal dissection of EGC in order to better inform treatment options.

• Early gastric cancer
• Endoscopic submucosal dissection indications
• Non-curative resection
• Salvage surgery
• Function-preserving surgery

• Endoscopic submucosal dissection
• Stomach
• Surgery
• Treatment outcome
• Undifferentiated histology

• Endoscopy
• Gastric cancer
• Screening

Cancer risk after radiation exposure during childhood has been extensively documented in the literature, although cancer risk associated with recurrent computed tomography (CT) scans during adulthood is less understood. We found a significant relationship between the frequency of CT scans and the subsequent incidence of secondary primary malignancies in patients who have undergone curative resection for early gastric cancer (EGC). On the basis of the low incidence of extragastric recurrence and the risk of radiation exposure, we suggest that overzealous CT surveillance should be avoided in adult patients with EGC.

Although computed tomography (CT) scans are very useful for identification or surveillance of malignancy, they are also associated with the risk of cancer caused by ionizing radiation. We investigated the risk of second primary malignancies (SPMs) after frequent abdominopelvic CT scans in a cohort of Korean patients with early gastric cancer (EGC). We performed a cohort study of 11,072 patients who underwent resection for EGC at Samsung Medical Center and validated the results using data from 7908 patients in a Korean National Health Insurance Service cohort. Cox proportional hazards regression model was used to estimate hazard ratios (HRs) for intra-abdominal SPM. During 43,766.5 person-years of the follow-up at our center, 322 patients developed intra-abdominal SPMs. Patients who underwent receiving >8 abdominopelvic CT scans had a significantly greater risk of developing SPM (HR, 2.73; 95% CI, 1.66–4.50; p < 0.001) than those who had with ≤8 scans. For each additional abdominopelvic CT scan, the adjusted HR for SPM was 1.09 (95% confidence interval (CI), 1.03–1.14). Similar results were observed in the Korean National Health Insurance Service cohort (adjusted HR, 1.14; 95% CI, 1.07–1.22). Significantly elevated risk of SPM was still observed when considering a 2-year latency period (adjusted HR, 2.43; 95% CI, 1.37–4.48) and a 3-year latency period (adjusted HR, 2.17; 95% CI, 1.06–4.47). Frequent abdominopelvic CT scans are associated with an elevated risk of SPMs after the treatment of EGC. Thus, physicians need to weigh carefully the clinical benefits of CT examinations against the potential risks of radiation exposure.

• computed tomography
• early gastric cancer
• radiation exposure

• Endoscopic submucosal dissection
• Gastric cancer
• Guideline
• Survival

• ESD
• gastric cancer
• prevention
• statin

Endoscopic submucosal dissection (ESD) is gaining enormous popularity in the treatment of early gastric cancers (EGCs) in many institutions across the world. However, appropriate selection of candidates for endoscopic resection is crucial to sufficiently mitigate non-e-curative (NEC) resection. This study aims at identifying the various clinico-pathologic factors that independently predict the NEC outcome and depth of submucosal invasion following ESD procedure in patients with EGC.

Multiple logistic regression analysis was applied to investigate factors that independently predict both non-curability phenomenon and the level of submucosal invasion in patients with early gastric neoplasia. Statistical Packages for the Social Sciences version 23 was used for analysis.

A total of 153 patients (162 EGC lesions) underwent en-bloc ESD after which the rate of complete resection and non-e-curative outcome were 95% and 22.2%, correspondingly. Multivariate analysis depicted that tumor location in the upper two third of stomach (odds ratio [OR], 5.46; 95% confidence interval [95% CI], 1.65–18.12; p = 0.006), tumor size > 2 cm (OR, 7.63; 95% CI, 2.29–25.42; p = 0.001), histologically undifferentiated tumor (OR, 15.54; 95% CI, 1.65–146.22; p = 0.001), and tumors with 0-IIa/0-IIc or their mixed variants with predominant 0-IIa/0-IIc (OR, 9.77; 95% CI, 1.23–77.65; p = 0.031) were all independent predictors of NEC resection for early gastric tumors. Additionally, location in the upper two third of the stomach (OR, 8.88; 95% CI, 2.90–27.17; p < 0.001), ulcerated lesions (OR, 3.70; 95% CI, 1.15–11.90; p = 0.028), lesions with > 2 cm (OR, 2.94; 95% CI, 1.08–8.02; p = 0.036) and those with poor differentiation (OR, 6.51; 95% CI, 2.23–18.98; p = 0.001) were found to have significant association with submucosal invasion.

Tumors located in the upper two third of the stomach having a larger size (> 2 cm), poor histo-differentiation and a gross type of 0-IIa/0-IIc or their mixed variants with predominant 0-IIa/0-IIc were significantly associated with a risk of NEC after ESD procedure. Thus, early gastric tumors displaying these features need to be handled carefully during endoscopic resection. Our findings may shed light on the pre-procedural detection of clinicopathologic factors that determine non-e-curability in patients with EGC.

• Clinico-pathologic factors
• ESD
• Early gastric cancer
• Non-e-curative resection

When patients with early gastric cancer (EGC) undergo non-curative endoscopic submucosal dissection requiring gastrectomy (NC-ESD-RG), additional medical resources and expenses are required for surgery. To reduce this burden, predictive model for NC-ESD-RG is required.

Data from 2,997 patients undergoing ESD for 3,127 forceps biopsy-proven differentiated-type EGCs (2,345 and 782 in training and validation sets, respectively) were reviewed. Using the training set, the logistic stepwise regression analysis determined the independent predictors of NC-ESD-RG (NC-ESD other than cases with lateral resection margin involvement or piecemeal resection as the only non-curative factor). Using these predictors, a risk-scoring system for predicting NC-ESD-RG was developed. Performance of the predictive model was examined internally with the validation set.

Rate of NC-ESD-RG was 17.3%. Independent pre-ESD predictors for NC-ESD-RG included moderately differentiated or papillary EGC, large tumor size, proximal tumor location, lesion at greater curvature, elevated or depressed morphology, and presence of ulcers. A risk-score was assigned to each predictor of NC-ESD-RG. The area under the receiver operating characteristic curve for predicting NC-ESD-RG was 0.672 in both training and validation sets. A risk-score of 5 points was the optimal cut-off value for predicting NC-ESD-RG, and the overall accuracy was 72.7%. As the total risk score increased, the predicted risk for NC-ESD-RG increased from 3.8% to 72.6%.

We developed and validated a risk-scoring system for predicting NC-ESD-RG based on pre-ESD variables. Our risk-scoring system can facilitate informed consent and decision-making for preoperative treatment selection between ESD and surgery in patients with EGC.

Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

• Early colorectal cancer
• Early gastric cancer
• Endoscopic resection
• Guideline
• Superficial esophageal squamous cell carcinoma

Recent evidence showed that combining endoscopic submucosal dissection (ESD) and laparoscopic sentinel lymph node dissection may avoid unnecessary gastrectomy in treating early mucinous gastric cancer (EMGC) patients with risks of positive lymph node metastasis (pLNM).

To explore the predictive factors for pLNM in EMGC, and to optimize the clinical application of combing ESD and sentinel lymph node dissection in a proper subgroup of patients with EMGC.

Thirty-one patients with EMGC who had undergone gastrectomy with lymph node dissection were consecutively enrolled from January 1988 to December 2016. Univariate and multivariate logistic regression analyses were used to estimate the association between the rates of pLNM and clinicopathological factors, providing odds ratio (OR) with 95% confidence interval. And the association between the number of predictors and the pLNM rate was also investigated.

Depth of invasion (OR = 7.342, 1.127-33.256, P = 0.039), tumor diameter (OR = 9.158, 1.348-29.133, P = 0.044), and lymphatic vessel involvement (OR = 27.749, 1.821-33.143, P = 0.019) turned out to be significant and might be the independent risk factors for predicating pLNM in the multivariate analysis. For patients with 1, 2, and 3 risk factors, the pLNM rates were 9.1%, 33.3%, and 75.0%, respectively. pLNM was not detected in seven patients without any of these risk factors.

ESD might serve as a safe and sufficient treatment for intramucosal EMGC if tumor size ≤ 2 cm, and when lymphatic vessel involvement is absent by postoperative histological examination. Combining ESD and sentinel lymph node dissection could be recommended as a safe and effective treatment for EMGC patients with a potential risk of pLNM.

• Endoscopic submucosal dissection
• Early gastric cancer
• Mucinous gastric cancer
• Laparoscopic sentinel lymph node dissection

• Adult
• Age Factors
• Aged
• Cohort Studies
• Disease-Free Survival
• Early Detection of Cancer
• Female
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Gastric Mucosa/pathology
• Gastroscopy/methods
• Humans
• Lymphatic Metastasis/diagnostic imaging
• Lymphatic Metastasis/pathology
• Male
• Middle Aged
• Monitoring, Physiologic/methods
• Neoplasm Invasiveness/pathology
• Neoplasm Recurrence, Local/diagnostic imaging
• Neoplasm Recurrence, Local/epidemiology
• Neoplasm Recurrence, Local/pathology
• Neoplasm Staging
• Predictive Value of Tests
• Prognosis
• Republic of Korea
• Retrospective Studies
• Risk Assessment
• Sex Factors
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Survival Analysis
• Tomography, X-Ray Computed/methods

• Endoscopic submucosal dissection
• Endoscopy
• Lymph nodes
• Neoplasms
• Stomach

• Adult
• Aged
• Asia
• Endoscopic Mucosal Resection
• Gastric Mucosa
• Humans
• Japan
• Middle Aged
• Neoplasm Recurrence, Local
• Retrospective Studies
• Stomach Neoplasms
• Treatment Outcome

• Endoscopic treatment
• Medication
• Recurrence
• Stomach neoplasm