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
Abstract
BACKGROUND

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

AIM

To examine risk factors for overall survival (OS) after additional surgery in patients with EGC who initially underwent ESD.

METHODS

This was a retrospective analysis of patients with EGC who underwent additional surgery after ESD at the Beijing Friendship Hospital affiliated to Capital Medical University between August 2012 and August 2019. OS was the primary outcome. Lymph node metastasis and residual tumor were secondary outcomes. Logistic regression models and Kaplan-Meier curves were used for further analysis.

RESULTS

Forty-two patients were evaluated, including 35 (83.3%) males and 7(16.7%) females. The mean age was 62 (range, 32-82) years. Male sex [hazard ratio (HR) = 21.906, 95% confidence interval (CI): 3.762-229.250; P = 0.039), T1b invasion (HR = 3.965, 95%CI: 1.109-17.432; P = 0.047), undifferentiated tumor (HR = 9.455, 95%CI: 0.946-29.482; P = 0.049), lymph node metastasis (HR = 2.126, 95%CI: 0.002-13.266; P = 0.031), and residual tumor (HR = 4.275, 95%CI: 1.049-27.420; P = 0.043) were independently associated with OS. The follow-up duration was 4-81 mo (median: 50.7 mo). OS was 77.0 ± 12.1 mo (95%CI: 53.3-100.7 mo). The 3-year and 5-year OS rates were 94.1% and 85%, respectively.

CONCLUSION

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

Keywords: Stomach neoplasms; Endoscopic submucosal dissection; Gastrectomy; Lymphatic metastasis; Neoplasm residual; Survival analysis

Core Tip: This was a retrospective study examining risk factors for overall survival after additional surgery in patients with early gastric cancer who initially underwent endoscopic submucosal dissection, especially the effects of lymph node metastasis and residual tumor. The results indicated that male sex, T1b invasion, undifferentiated tumor, lymph node metastasis, and residual tumor were independently associated with overall survival in patients with early gastric cancer who underwent additional surgery after endoscopic submucosal dissection.