Risk Factors Of Synchronous And Metachronous Gastric Cancer After ESD For Early Gastric Cancer

Objective: With the development of endoscopic technology,endoscopic submucosal dissection(ESD)has become the main treatment for early gastric cancer,but some lesions after ESD will be secondary to synchronous and metachronous gastric cancer.This article mainly discusses the risk factors that may affect the occurrence of synchronous and metachronous gastric cancer.Methods: Follow up the patients who underwent ESD resection in the our hospital from January 2015 to January 2020,and record the endoscopic follow-up results.The new lesions found within 12 months were defined as synchronous gastric cancer,and the new lesions found more than 12 months were defined as metachronous gastric cancer.The clinical information and pathological findings of these patients were collected retrospectively,including age,gender,smoking history,family history,histological differentiation,tumor invasion depth,multifocality,tumor size,initial lesion location,background mucosal atrophy and intestinal metaplasia.Objective to explore the risk factors of synchronous and metachronous gastric cancer after ESD for early gastric cancer.Results:1)A total of 120 patients were included in this study.The average age was 64 years old,male accounted for 58.3%.The average diameter of the first lesion was about 1.9cm.During the follow-up period of 3-60 months,a total of 25(20.8%)patients had multiple lesions(synchronous or metachronous lesions),of which 14(11.7%)had metachronous lesions and 11(9.2%)had synchronous gastric cancer.2)Univariate analysis showed that patients with age ≥65 years old(P=0.001),male(P=0.021),heavy smoking(BI≥400)(P=0.029),one third lower than the initial lesion location(P=0.008),background mucosal O-type atrophy(P=0.047),severe intestinal metaplasia(P=0.016),and differentiated gastric cancer(P=0.002)were more likely to have multiple lesions(synchronous or metachronous gastric cancer).However,family history of gastric cancer(P=0.104),multifocal lesions(P=1.000),tumor size(P=0.515),and tumor invasion depth(P=0.361)were not associated with multiple lesions(synchronous or metachronous gastric cancer).The multiva-riate analysis showed that the initial lesion in the lower third of the stomach(OR=11.280,95%CI 2.720 ～46.775,P=0.001),severe intestinal metaplasia(OR=6.206,95%CI 1.667～23.109,P=0.006)and differentiated adenocarcinoma(OR=9.178,95%CI 1.642～51.305,P=0.012)were independent risk factors for multiple lesions(synchronous or metachronous gastric lesions).3)Subgroup analysis: For synchronous gastric cancer,univariate analysis showed that patients with age ≥65 years old(P=0.025)and severe intestinal metaplasia(P=0.045)were correlated,but multivariate analysis showed that patients with age ≥65 years old(OR=2.458,95%CI 0.404 ～ 14.958,P=0.329)and severe intestinal metaplasia(OR=4.711,95%CI 0.969～22.896,P=0.055)were not correlated.Therefore,there was no independent risk factor for synchronous gastric cancer.For metachronous gastric cancer,univariate analysis showed that age≥65 years old(P = 0.004),male(P = 0.022),the initial lesion in the lower third of the stomach(P = 0.013),severe intestinal metaplasia(P= 0.026)and differentiated gastric cancer(P= 0.021)associated with it.The multivariate analysis showed that the initial lesion in the lower third of the stomach(OR = 14.634,95%CI 2.476-86.481,P = 0.003),severe intestinal metaplasia(OR=14.870,95%CI 2.508～88.166,P=0.003)and differentiated adenocarcinoma(OR=4.484,95%CI 1.029～19.536,P=0.046)were independent risk factors.4)For metachronous neoplasia,the median follow-up time was 22 months,and the cumulative 5-year incidence was 25.75%.Conclusions: For men over 65 years old with a history of heavy smoking,with severe gastric mucosal atrophy and intestinal metaplasia,and the location of the initial lesion is lower than one-third,the early gastric cancer patients with differentiated adenocarcinoma are more likely to have synchronous and metachronous gastric cancer after ESD,among which the initial lesion is lower than one-third,severe intestinal metaplasia and differentiated adenocarcinoma are the independent risk factors of metachronous gastric cancer Risk factors.So,For patients with such characteristics,even if the follow-up time is more than 1 year,we should pay attention to the occurrence of metachronous gastric cancer for more than 1 year.