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Long-term outcomes of endoscopic submucosal dissection in comparison to surgery in undifferentiated-type intramucosal gastric cancer using propensity score analysis.
- Source :
-
Surgical Endoscopy & Other Interventional Techniques . Apr2018, Vol. 32 Issue 4, p2046-2057. 12p. 1 Diagram, 3 Charts, 2 Graphs. - Publication Year :
- 2018
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Abstract
- <bold>Background: </bold>The treatment of intramucosal early gastric cancer with undifferentiated-type histologies (UD-EGCs) using endoscopic submucosal dissection (ESD) is controversial. This study aimed to compare the clinical and oncologic long-term outcomes of ESD and surgery for UD-EGCs.<bold>Methods: </bold>A prospectively collected database of patients who underwent ESD or surgery between January 2006 and December 2012 was established. Patients who diagnosed with UD-EGC and satisfied the expanded indications of ESD were included. Clinical data from 111 patients treated with ESD and 382 patients underwent surgery were analyzed, and 1-1 propensity score-matched 81 pairs of patients were also compared.<bold>Results: </bold>In both groups, two-thirds of the UD-EGCs had signet ring cell (SRC)-type histology and about 90% of UD-EGCs were flat or depressed types. The mean size of tumors was smaller in ESD group (9.7 vs. 13.2 mm; P < 0.001). After propensity score-matched, case-matching covariates were not significantly different between the groups. Disease-free survival (DFS) was significantly shorter in the ESD group, but overall survival (OS) was not different between the two groups both in overall comparison (DFS; P < 0.001 and OS; P = 0.078) and propensity score-matched analysis (DFS; P < 0.001 and OS; P = 0.850). According to histologic type, OS of SRC histology was not different between the group, both in overall comparison and propensity score-matched analysis (P = 0.286 and P = 0.210). On the other hands, OS of poorly differentiated adenocarcinoma was significantly shorter in ESD group in overall comparison (P = 0.007), but was not as so in propensity score-matched analysis (P = 0.088).<bold>Conclusions: </bold>ESD might be a complementary option for the treatment of UD-EGCs, especially in those with SRC-type histology based on strict expanded indications. Nonetheless, close endoscopic surveillance is required because of a high incidence of intragastric recurrence. [ABSTRACT FROM AUTHOR]
- Subjects :
- *ONCOLOGY
*PROGRESSION-free survival
*HISTOLOGY
*PROPENSITY score matching
*ADENOCARCINOMA
*COMPARATIVE studies
*GASTRECTOMY
*LONGITUDINAL method
*RESEARCH methodology
*MEDICAL cooperation
*PROBABILITY theory
*RESEARCH
*STOMACH tumors
*SURVIVAL analysis (Biometry)
*LOGISTIC regression analysis
*EVALUATION research
*TREATMENT effectiveness
*RETROSPECTIVE studies
Subjects
Details
- Language :
- English
- ISSN :
- 18666817
- Volume :
- 32
- Issue :
- 4
- Database :
- Academic Search Index
- Journal :
- Surgical Endoscopy & Other Interventional Techniques
- Publication Type :
- Academic Journal
- Accession number :
- 128397721
- Full Text :
- https://doi.org/10.1007/s00464-017-5901-6