Research On Endoscopic Diagnosis And Treatment Of Undifferentiated Early Gastric Cancer

Part I Risk factors for beyond endoscopic resection extended indication of undifferentiated early gastric cancerIntroduction:Endoscopic resection of undifferentiated early gastric cancer(UD-EGC)remains controversial.Aims are to explore the risk factors associated with beyond endoscopic resection extended indication of UD-EGC patients,based on its endoscopic findings,so as to provide diagnostic evidences for choosing UD-EGC cases correctly in clinical work.Materials and Methods:We retrospectively reviewed the clinical data of patients who underwent endoscopic submucosal dissection(ESD)or radical gastrectomy at Cancer Hospital,Chinese Academy of Medical Sciences(CAMS),from 2011 to 2018.Patients were divided into within extended indication group and beyond extended indication group,according to 4th Japanese Gastric Cancer Association Guideline.The endoscopic findings and clinicopathologic characteristics were compared between the groups to identify the risk factors for beyond ESD extended indication of UD-EGC.A scoring system was created based on logistic regression modeling.Results:A total of 793 patients were identified as UD-EGC postoperatively,including 1 58 ESD patients and 635 gastrectomy patients.Of these,628 patients were beyond extended indication of ESD.Endoscopic atrophy type,superficial elevated and depressed type,surface redness,and enlarged folds were associated with beyond extended indication of ESD.The points of risk scores for these variables were assigned based on the ?-coefficient as follows:O-type atrophy,2-points;C-type atrophy,1-point;superficial elevated and depressed type,1-point;surface redness,1-point;enlarged folds,1-point.The risk scoring model showed a satisfactory discriminatory performance on internal validation(area under the curve(AUC):0.847;95%confidence interval(CI):0.814-0.880).Conclusions:UD-EGC with atrophy,superficial elevated and depressed,surface redness and enlarged folds endoscopic findings,have high beyond ESD extended indication rate.A simple and practical prediction model based on this result can provide useful information for endoscopists to choose UD-EGC patients within ESD extended indication.Part ?A retrospective study comparing endoscopic submucosal dissection(ESD)with surgery in the treatment of early gastric cancer(EGC)Introduction:The purpose of this study was to to analyze the long-term efficacy of endoscopic submucosal dissection(ESD)in the treatment of early gastric cancer(EGC).Materials and Methods:We retrospectively reviewed EGC patients who underwent endoscopic submucosal dissection(ESD)at Cancer Hospital.Chinese Academy of Medical Sciences(CAMS),from January 2009 to December 2016.The incidence of local recurrence,synchronous cancer and heterogeneous cancer were analyzed.Kaplan-meier method was used to analyze 5-year recurrence free survival(RFS)and 5-year overall survival(OS)of all patients.Results:A total of 255 EGC patients were enrolled in this study.included 175 differentiated early gastric cancer(D-EGC)patients and 80 undifferentiated early gastric cancer(UD-EGC)patients.Among them.171 patients within extended indication and 84 patients beyond extended indication.In this study.the incidence rates of local recurrence,synchronous cancer and heterogeneous cancer were 1.96%,1.96%and 2.35%,respectively.There was no difference in local recurrence rate of-D-EGC group and UD-EGC group(P=0.675),but the incidence rates of synchronous and heterogenous cancer in the D-EGC group was higher than that of UD-EGC group,although there was no significant difference(P=0.580,P=0.094).There was no significant difference in 5-year recurrence free survival(91.3%vs.95.9%.P=0.236)and 5-year overall survival(100%vs.98.6%,P=0.1 56)between D-EGC group and UD-EGC group.Conclusions:The long-term outcome of ESD in the treatment of early gastric cancer was good.More attention should be paid to the occurrence of local recurrence and heterogeneous cancer in EGC patients after ESD.When these lesions undergo ESD once again,patients also have a good long-term outcome.Part ? Efficacy comparison between endoscopic submucosal dissection and surgical resection of early gastric cancer with undifferentiated histology-propensity score analysisIntroduction:Endoscopic resection of undifferentiated early gastric cancer(UD-EGC)remains controversial.The purpose of this study was to compare long-term clinical outcomes of UD-EGC between ESD and surgical resection groups.Materials and Methods:We retrospectively reviewed UD-EGC patients who underwent endoscopic submucosal dissection(ESD)or surgery at Cancer Hospital,Chinese Academy of Medical Sciences(CAMS),from January 2009 to December 2016.Kaplan-meier method was used to analyze 5-year recurrence free survival rate and 5-year overall survival rate of the two groups.Results:A total of 569 patients were identified as UD-EGC postoperatively,included 79 ESD group patients and 480 surgery group patients.Among them,10 ESD group patients received additional surgery after ESD operation.After 1:1 propensity score-matched.case-matching covariates showed no significantly difference between the groups,and 61 pairs of patients were compared.There was no significant difference in 5-year recurrence free survival rate(98.2%vs.96.7%,P=0.641)and 5-year overall survival rate(98.2%vs.96.6%,P?0.680)between the ESD group and the surgical group.Conclusions:The long-term outcome of ESD for UD-EGC was comparable to that of surgery.On the basis of following the indications for UD-EGC,additional surgery should be selected for cases with high risk of lymph node metastasis...