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Mo1121 Different Clinical Features Distinguishing Early From Late Metachronous Gastric Tumors After Endoscopic Submucosal Dissection of Early Gastric Cancer
Abstracts
Mo1121 Different Clinical Features Distinguishing Early From Late Metachronous Gastric Tumors After Endoscopic Submucosal Dissection of Early Gastric Cancer Jae Yong Park*, Sang Gyun Kim, Jung Kim, Seung Jun Han, Jooyoung Lee, Sooyeon Oh, Ji Min Choi, Joo Hyun Lim, Hyun Chae Jung Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea (the Republic of)
Figure 1: Identification of low/high group among patients with cancer and UGIB by score.
Mo1120 Endoscopic Submucosal Dissection for Early Gastric Cancer in Very Elderly Patients Age 85 or Older Takumi Yanagita*1, Ko Watanabe2,1, Takuto Hikichi2, Jun Nakamura2,1, Tadayuki Takagi1, Rei Suzuki1, Mitsuru Sugimoto1, Hitomi Kikuchi2,1, Naoki Konno1, Yuichi Waragai1, Hiroyuki Asama1, Yuki Sato1, Katsutoshi Obara3, Hiromasa Ohira1 1 Gastroenterology, Fukushima Medical University, Fukushima, Japan; 2 Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan; 3Advanced Gastrointestinal Endoscpy, Fukushima Medical University, Fukushima, Japan
Background: Metachronous gastric tumor (MGT) is one of major concerns after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Adequate follow-up strategy after ESD is still not well established. The aim of this study was to identify the different clinical features of patients with EGC according to the time to development of MGT. Methods: Among 1,780 consecutive patients with EGC who underwent ESD between 2005 and 2014 in Seoul National University Hospital, 115 patients with MGT were retrospectively enrolled. MGT was defined as secondary gastric adenoma or cancer detected > 1 year after initial ESD. Clinical characteristics of the patients and the index cancer were evaluated to find out the factors associated with early occurrence of MGT. Results: The mean interval to development of MGT after ESD was 37 months (range: 12-111). In univariate analysis, the interval to MGT was shorter if the initial lesion showed non-elevated gross type (39.4 vs 57.0 months, p Z 0.011), and absence of synchronous primary lesions also showed almost significant tendency toward early occurrence (< 36 months) (39.8 vs 51.4 months, p Z 0.050). Further analysis with Cox’s proportional hazards model revealed that these two factors were independent risk factors for early occurrence of MGT, and the hazard ratios were 1.966 (95% CI: 1.141-3.386, p Z 0.015), 1.911 (95% CI: 1.1633.141, p Z 0.011), respectively. Characteristics of MGT lesions showed no difference between the patients with early occurrence (< 3 years) and the patients with late occurrence (>3 years) in terms of histologic type (cancer, 76.9% vs 82.5%, p Z 0.454), gross type (non-elevated type, 88.6% vs 86.4%, pZ1.000), and differentiation of MGT (differentiated type, 82.1% vs 78.0%, pZ0.637). There was no significant difference in the interval to development of MGT between the patients with successful Helicobacter pylori eradication and the patients with persistent infection (pZ0.502). Mean follow-up duration for the patients with MGT was 76.9 26.6 months. Conclusion: The incidence rate of MGT was not constant over time after ESD for EGC. Non-elevated gross type and absence of synchronous gastric tumor were independent risk factors for early development of MGT. Meticulous endoscopic inspection is especially important during the early follow-up period in the patients with these initial tumor characteristics. Long-term regular endoscopic follow-up may be beneficial regardless of H. pylori eradication, in patients with adequate life expectancy without significant comorbidities.
Table. Multivariate analysis of risk factors for early occurrence of metachronous gastric tumor after endoscopic resection of EGC Variables Gross type (non-elevated) Synchronous gastric cancer or adenoma (no) Gender (male) Helicobacter pylori infection (yes) IM of antral mucosa (absent to mild)
HR 1.890 1.606 1.684 1.973 1.255
95% CI 1.104-3.238 1.004-2.570 0.849-3.340 0.822-1.973 0.804-1.959
p-value 0.020 0.048 0.136 0.279 0.318
IM, intestinal metaplasia; HR, hazard ratio; CI, confidence interval.
Aims: The safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in very elderly patients remains unclear. The aim of this study was to evaluate the safety and efficacy of ESD for EGC in patients age 85 years and older. Methods: Patients who underwent ESD for EGC between September 2003 and April 2015 were divided into 3 groups: the very elderly (85 years; 43 patients), the elderly (65-84 years; 511 patients), and the non-elderly (64 years; 161 patients). Adverse events (AEs) were used as the primary endpoint to assess the safety of ESD, and the ESD treatment outcomes (i.e., en bloc resection rate, complete en bloc resection rate, and curative resection rate) and the overall survival rate after ESD were the secondary endpoints. These parameters were retrospectively evaluated in the 3 groups. Results: There were no significant differences in AEs (non-elderly, elderly, and very elderly: 7.3, 9.5, and 12.5%, respectively, P Z 0.491) or in the en bloc resection and complete en bloc resection rates among the three groups. However, there was a significant difference in the curative resection rates (nonelderly, elderly, and very elderly: 91.5, 84.1, and 77.1%, respectively, P Z 0.014). Regarding overall survival, there was a significant difference among the three groups (1-, 5-, and 10-year overall survival rates: non-elderly: 98.6, 90.2, and 74.7%; elderly: 97.2, 86.2, and 61.9%; and very elderly: 92.7, 66.8, and 34.4%, respectively, P Z 0.001). Moreover, the overall survival rate in the very elderly patients with cardiovascular disease was significantly lower than that in the very elderly patients without cardiovascular disease (P < 0.001). Conclusion: ESD is an acceptable treatment for EGC in patients 85 years of age or older in terms of safety. However, the overall survival after ESD in the very elderly patients with cardiovascular disease was short.
Fig. Kaplan-Meier curve of the cumulative incidence of metachronous gastric tumor after ESD for EGC. (nZ115)
AB436 GASTROINTESTINAL ENDOSCOPY Volume 85, No. 5S : 2017
www.giejournal.org
Mo1121 Different Clinical Features Distinguishing Early From Late Metachronous Gastric Tumors After Endoscopic Submucosal Dissection of Early Gastric Cancer Jae Yong Park*, Sang Gyun Kim, Jung Kim, Seung Jun Han, Jooyoung Lee, Sooyeon Oh, Ji Min Choi, Joo Hyun Lim, Hyun Chae Jung Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea (the Republic of)
Figure 1: Identification of low/high group among patients with cancer and UGIB by score.
Mo1120 Endoscopic Submucosal Dissection for Early Gastric Cancer in Very Elderly Patients Age 85 or Older Takumi Yanagita*1, Ko Watanabe2,1, Takuto Hikichi2, Jun Nakamura2,1, Tadayuki Takagi1, Rei Suzuki1, Mitsuru Sugimoto1, Hitomi Kikuchi2,1, Naoki Konno1, Yuichi Waragai1, Hiroyuki Asama1, Yuki Sato1, Katsutoshi Obara3, Hiromasa Ohira1 1 Gastroenterology, Fukushima Medical University, Fukushima, Japan; 2 Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan; 3Advanced Gastrointestinal Endoscpy, Fukushima Medical University, Fukushima, Japan
Background: Metachronous gastric tumor (MGT) is one of major concerns after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Adequate follow-up strategy after ESD is still not well established. The aim of this study was to identify the different clinical features of patients with EGC according to the time to development of MGT. Methods: Among 1,780 consecutive patients with EGC who underwent ESD between 2005 and 2014 in Seoul National University Hospital, 115 patients with MGT were retrospectively enrolled. MGT was defined as secondary gastric adenoma or cancer detected > 1 year after initial ESD. Clinical characteristics of the patients and the index cancer were evaluated to find out the factors associated with early occurrence of MGT. Results: The mean interval to development of MGT after ESD was 37 months (range: 12-111). In univariate analysis, the interval to MGT was shorter if the initial lesion showed non-elevated gross type (39.4 vs 57.0 months, p Z 0.011), and absence of synchronous primary lesions also showed almost significant tendency toward early occurrence (< 36 months) (39.8 vs 51.4 months, p Z 0.050). Further analysis with Cox’s proportional hazards model revealed that these two factors were independent risk factors for early occurrence of MGT, and the hazard ratios were 1.966 (95% CI: 1.141-3.386, p Z 0.015), 1.911 (95% CI: 1.1633.141, p Z 0.011), respectively. Characteristics of MGT lesions showed no difference between the patients with early occurrence (< 3 years) and the patients with late occurrence (>3 years) in terms of histologic type (cancer, 76.9% vs 82.5%, p Z 0.454), gross type (non-elevated type, 88.6% vs 86.4%, pZ1.000), and differentiation of MGT (differentiated type, 82.1% vs 78.0%, pZ0.637). There was no significant difference in the interval to development of MGT between the patients with successful Helicobacter pylori eradication and the patients with persistent infection (pZ0.502). Mean follow-up duration for the patients with MGT was 76.9 26.6 months. Conclusion: The incidence rate of MGT was not constant over time after ESD for EGC. Non-elevated gross type and absence of synchronous gastric tumor were independent risk factors for early development of MGT. Meticulous endoscopic inspection is especially important during the early follow-up period in the patients with these initial tumor characteristics. Long-term regular endoscopic follow-up may be beneficial regardless of H. pylori eradication, in patients with adequate life expectancy without significant comorbidities.
Table. Multivariate analysis of risk factors for early occurrence of metachronous gastric tumor after endoscopic resection of EGC Variables Gross type (non-elevated) Synchronous gastric cancer or adenoma (no) Gender (male) Helicobacter pylori infection (yes) IM of antral mucosa (absent to mild)
HR 1.890 1.606 1.684 1.973 1.255
95% CI 1.104-3.238 1.004-2.570 0.849-3.340 0.822-1.973 0.804-1.959
p-value 0.020 0.048 0.136 0.279 0.318
IM, intestinal metaplasia; HR, hazard ratio; CI, confidence interval.
Aims: The safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in very elderly patients remains unclear. The aim of this study was to evaluate the safety and efficacy of ESD for EGC in patients age 85 years and older. Methods: Patients who underwent ESD for EGC between September 2003 and April 2015 were divided into 3 groups: the very elderly (85 years; 43 patients), the elderly (65-84 years; 511 patients), and the non-elderly (64 years; 161 patients). Adverse events (AEs) were used as the primary endpoint to assess the safety of ESD, and the ESD treatment outcomes (i.e., en bloc resection rate, complete en bloc resection rate, and curative resection rate) and the overall survival rate after ESD were the secondary endpoints. These parameters were retrospectively evaluated in the 3 groups. Results: There were no significant differences in AEs (non-elderly, elderly, and very elderly: 7.3, 9.5, and 12.5%, respectively, P Z 0.491) or in the en bloc resection and complete en bloc resection rates among the three groups. However, there was a significant difference in the curative resection rates (nonelderly, elderly, and very elderly: 91.5, 84.1, and 77.1%, respectively, P Z 0.014). Regarding overall survival, there was a significant difference among the three groups (1-, 5-, and 10-year overall survival rates: non-elderly: 98.6, 90.2, and 74.7%; elderly: 97.2, 86.2, and 61.9%; and very elderly: 92.7, 66.8, and 34.4%, respectively, P Z 0.001). Moreover, the overall survival rate in the very elderly patients with cardiovascular disease was significantly lower than that in the very elderly patients without cardiovascular disease (P < 0.001). Conclusion: ESD is an acceptable treatment for EGC in patients 85 years of age or older in terms of safety. However, the overall survival after ESD in the very elderly patients with cardiovascular disease was short.
Fig. Kaplan-Meier curve of the cumulative incidence of metachronous gastric tumor after ESD for EGC. (nZ115)
AB436 GASTROINTESTINAL ENDOSCOPY Volume 85, No. 5S : 2017
www.giejournal.org