Clinical outcomes and risk factors of non-curative endoscopic submucosal dissection for early gastric cancer: a retrospective multicenter study in Zhejiang, China

Chao-Qiong Jin; Jing Zhao; Xiao-Yun Ding; Liang-Liang Yu; Guo-Liang Ye; Xin-Jian Zhu; Jian-Wei Shen; Ye Yang; Bo Jin; Chun-Li Zhang; Bin Lv

doi:10.3389/fonc.2023.1225702

Clinical outcomes and risk factors of non-curative endoscopic submucosal dissection for early gastric cancer: a retrospective multicenter study in Zhejiang, China

Front Oncol. 2023 Oct 3:13:1225702. doi: 10.3389/fonc.2023.1225702. eCollection 2023.

Authors

Chao-Qiong Jin^{1

2}, Jing Zhao¹, Xiao-Yun Ding³, Liang-Liang Yu⁴, Guo-Liang Ye⁵, Xin-Jian Zhu⁶, Jian-Wei Shen⁷, Ye Yang⁸, Bo Jin⁹, Chun-Li Zhang¹⁰, Bin Lv^{1

11}

Affiliations

¹ Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
² Department of Gastroenterology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.
³ Department of Gastroenterology, Laboratory of Digestive Diseases, Ningbo First Hospital, Ningbo, China.
⁴ Department of Gastroenterology, Sir Run Run Shaw Hospital Affiliated Hospital of Zhejiang University, Hangzhou, China.
⁵ Department of Gastroenterology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China.
⁶ Department of Gastroenterology, Shaoxing Shangyu People's Hospital, Shaoxing, Zhejiang, China.
⁷ Department of Gastroenterology, Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, China.
⁸ Department of Gastroenterology, HwaMei Hospital, University Of Chinese Academy Of Sciences, Ningbo, China.
⁹ Gastrointestinal Endoscopy Center, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
¹⁰ Department of Pathology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
¹¹ Key Laboratory of Digestive Pathophysiology of Zhejiang Province, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.

Abstract

Background: Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) does not always lead to curative resection. Risk factors of lymph node metastasis (LNM)/local cancer residue after non-curative ESD for EGC have not been fully elucidated. We therefore aimed to clarify them and evaluate whether the "eCura system" is reliable for the risk stratification of LNM after non-curative ESD.

Methods: We conducted a multicenter retrospective study at seven institutions in Zhejiang, China, on 128 patients who underwent non-curative ESD for EGC. We divided the patients into two groups according to their therapeutic regimen after non-curative ESD. We analyzed the risk factors for LNM, local cancer residue, cancer recurrence, and cancer-specific mortality. Furthermore, we compared the outcomes in each risk category after applying the "eCura system".

Results: Among 68 patients undergoing additional surgery, LNM was found in three (4.41%) patients, while local cancer residue was found in eight (11.76%) patients. Multivariate analysis showed that upper third location and deep submucosal invasion were independent risk factors of LNM and local cancer residue. Among 60 patients who underwent simple follow-up, local cancer recurrence was found in four (6.67%) patients and cancer-specific mortality was found in one (1.67%) patient. There were no independent risk factors of cancer recurrence and cancer-specific mortality in our study. During the follow-up period, 5-year overall survival (OS) and disease-free survival (DFS) were 93.8% and 88.9%, respectively. Additionally, LNM and cancer recurrence were significantly associated with the eCura scoring system (p = 0.044 and p = 0.017, respectively), while local cancer residue and cancer-specific mortality were not (p = 0.478 and p = 0.131, respectively).

Conclusion: Clinicians should be aware of the risk factors for the prognosis of patients with non-curative ESD to determine subsequent treatment. Through the application of the "eCura system", additional surgery should be performed in patients with intermediate/high risk of LNM.

Keywords: cancer recurrence; eCura system; early gastric cancer; endoscopic submucosal dissection; lymph node metastasis; risk factors.

Grants and funding

Supported by the National Natural Science Foundation of China under grant numbers 81770535 and 81970470 and TCM-WM Collaborating Centre for Diagnose and Treatment of Refractory and Difficult and Complicated Diseases “Gastric Cancer”.