Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2017; 9(8): 327-332
Published online Aug 15, 2017. doi: 10.4251/wjgo.v9.i8.327
Gastric xanthoma is a predictive marker for metachronous and synchronous gastric cancer
Narihiro Shibukawa, Shohei Ouchi, Shuji Wakamatsu, Yuhei Wakahara, Akira Kaneko
Narihiro Shibukawa, Shohei Ouchi, Shuji Wakamatsu, Yuhei Wakahara, Akira Kaneko, Department of Gastroenterology, NTT West Osaka Hospital, Tennoji-ku, Osaka 543-8922, Japan
Author contributions: Shibukawa N, Ouchi S, Wakamatsu S, Wakahara Y and Kaneko A contributed equally to this work; Shibukawa N designed the research; Shibukawa N, Ouchi S, Wakamatsu S, Wakahara Y and Kaneko A performed the research; Shibukawa N and Kaneko A analyzed the data and wrote the paper.
Institutional review board statement: This study was reviewed and approved by the NTT West Osaka Hospital Ethics Committee.
Informed consent statement: Because of the anonymous nature of the data obtained after each patient had provided written informed consent for ESD, the requirement for informed consent was waived.
Conflict-of-interest statement: All authors have no conflict of interest to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Dr. Narihiro Shibukawa, Department of Gastroenterology, NTT West Osaka Hospital, 2-6-40 Karasugatsuji, Tennoji-ku, Osaka 543-8922, Japan. narihiro.shibukawa.pc@west.ntt.co.jp
Telephone: +81-6-67737111 Fax: +81-6-67722302
Received: December 16, 2016
Peer-review started: December 20, 2016
First decision: January 18, 2017
Revised: April 24, 2017
Accepted: May 18, 2017
Article in press: May 19, 2017
Published online: August 15, 2017
Processing time: 237 Days and 4.1 Hours
Abstract
AIM

To investigate predictive markers for metachronous and synchronous gastric cancer (GC), which can develop after endoscopic submucosal dissection (ESD).

METHODS

A total of 352 patients underwent ESD for early GC at NTT West Osaka Hospital between June 2006 and February 2016. Exclusion criteria were as follows: Remnant stomach, unknown Helicobacter pylori status, and endoscopic observation of the whole stomach outside our hospital. We analyzed data from 192 patients comprising 109 patients with solitary GC (Group A) and 83 with metachronous and synchronous GC (Group B). We retrospectively investigated the clinicopathological and endoscopic characteristics, and endoscopic risk score as predictive markers for GC.

RESULTS

The median age of Group B [72 years (interquartile range 63-78)] was significantly higher than that of Group A [66 years (interquartile range 61-74), respectively, P = 0.0009]. The prevalence of intestinal metaplasia in Group B tended to be higher than that in Group A (57.8% vs 45.0%, P = 0.08). The prevalence of gastric xanthoma (GX) in Group B was significantly higher than that in Group A (54.2% vs 32.1%, P = 0.003). The atrophy score in Group B was significantly higher than that in Group A (P = 0.005). Multivariate analysis revealed that higher age and the presence of GX were independently related to metachronous and synchronous GC [OR = 1.04 (1.01-1.08), P = 0.02; and OR = 2.11 (1.14-3.99), P = 0.02, respectively].

CONCLUSION

The presence of GX is a useful predictive marker for metachronous and synchronous GC.

Keywords: Gastric cancer; Metachronous neoplasms; Synchronous neoplasms; Xanthoma; Biomarker

Core tip: This was a retrospective observational study to identify predictive markers for metachronous and synchronous gastric cancer (GC). Multivariate analysis revealed that higher age and the presence of gastric xanthoma were independently related to the development of metachronous and synchronous GC. Additional large prospective studies are necessary to investigate this important issue further.