Prognostic factors for ESD of early gastric cancers: a systematic review and meta-analysis

Michele Oliveira De Marco; Francisco Tustumi; Vitor Ottoboni Brunaldi; Ricardo Hannum Resende; Carolina Ogawa Matsubayashi; Elisa Ryoka Baba; Dalton Marques Chaves; Wanderley Marques Bernardo; Eduardo Guimarães Hourneaux de Moura

doi:10.1055/a-1201-3089

Endoscopy International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(09): E1144-E1155
DOI: 10.1055/a-1201-3089

Review

Prognostic factors for ESD of early gastric cancers: a systematic review and meta-analysis

Michele Oliveira De Marco

¹Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil

,

Francisco Tustumi

²Department of Gastroenterology, Digestive Surgery Division, Sao Paulo School of Medicine

,

Vitor Ottoboni Brunaldi

³Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil; Center for Gastrointestinal Endoscopy, Surgery and Anatomy Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil

,

Ricardo Hannum Resende

¹Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil

,

Carolina Ogawa Matsubayashi

¹Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil

,

Elisa Ryoka Baba

¹Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil

,

Dalton Marques Chaves

¹Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil

,

Wanderley Marques Bernardo

⁴University São Paulo Medical School - São Paulo, Brazil – Thoracic Surgery Department

,

Eduardo Guimarães Hourneaux de Moura

¹Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil

› Institutsangaben

Abstract

Background and study aims Gastric neoplasms are one of the leading types of cancer in the world and early detection is essential to improve prognosis. Endoscopy is the gold-standard diagnostic procedure and allows adequate treatment in selected cases. Endoscopic submucosal dissection (ESD) has been reported to safely address most early gastric cancers (EGCs), with high curability rates. However, data on prognostic factors related to ESDs of EGCs are conflicting. Therefore, we aimed to systematically review the available literature and to perform a meta-analysis to identify the relevant prognostic factors in this context.

Methods We performed this study according to PRISMA guidelines. Comparative studies assessing the relationship between curative resection or long-term curability rates and relevant prognostic factors were selected. Prognostic factors were demographic data, lesion features (location, morphology of the lesion, size, and depth of invasion), histological findings, Helycobacter pylori (HP) infection, presence of gastric a atrophy and body mass index (BMI). Finally, we also evaluated risk factors related to metachronous gastric neoplasm.

Results The initial search retrieved 2829 records among which 46 studies were included for systematic review and meta-analysis. The total sample comprised 28366 patients and 29282 lesions. Regarding curative resection, pooled data showed no significant influence of sex [odds ratio (OR): 1.15 (0,97, 1.36) P = 0.10 I² = 47 %] , age [OR: 1.00 (0.61, 1.64) P = 1.00 I² = 58 %], posterior vs non-posterior location [OR: 1.35 (0.81, 2.27) P = 0.25 I² = 84 %], depressed vs von-depressed macroscopic type[OR: 1.21 (0.99, 1.49) P = 0.07 I² = 0 %], non-upper vs upper location [OR: 1.41 (0.93, 2.14) P = 0.10 I² = 77 %] and BMI [OR: 0.84 (0.57; 1.26) P = 0.41 I² = 0 %]. Differentiated neoplasms presented greater chance of cure compare to undifferentiated [OR: 0.10 (0.07, 0.15) P < 0.00001 I² = 0 %]. Ulcerated lesions had lower curative rates compared to non-ulcerated [OR: 3.92 (2.81, 5.47) P < 0.00001 I² = 44 %]. Lesions smaller than 20 mm had greater chance of curative resection [OR: 3.94 (3.25, 4.78) P < 0.00001 I² = 38 %]. Bleeding during procedure had lower curative rates compared to non-bleeding [OR: 2.13 (1.56, 2.93) P < 0.0001 I² = 0 %]. Concerning long-term cure, female gender [OR 1.62 (1.33, 1.97) P < 0.00001 I² = 0 %] and the mucosal over SM1 cancers were protective factors [OR: 0.08 (0.02, 0.39) P = 0.002 I² = 86 %]. Gastric atrophy [OR: 0.60 (0.45, 0.81) P = 0.0006 I² = 42 %] and the pepsinogen I/pepsinogen II ratio [OR 2.29 (1.47, 3.57) P = 0.0002 I² = 0 %] were risk factors to metachronous gastric neoplasm.

Conclusions Ulcerated lesions, histology, bleeding and size > 20 mm are prognostic factors concerning curative resection. Regarding long-term cure, female gender and mucosal over SM1 cancer are predictive factors. Gastric atrophy and the pepsinogen ratio are risk factors for metachronous gastric neoplasm.

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Referenzen

References
1 Cutsem EV, Sagaert X, Topal B. et al. Gastric cancer. Lancet 2016; 388: 2654-2664
2 Kim J, Kim SS. Early Detection is Important to Reduce the Economic Burden of Gastric Cancer. J Gastric Cancer 2018; 18: 82-89
3 Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Available from [homepage on the internet]: http://www.jgca.jp/pdf/JGCA_Jpn_Classification_3rd_Eng.pdf
4 Choi JM, Kim JG, Yang HJ. et al. Endoscopic predictors for undifferentiated histology in differentiated gastric neoplasms prior to endoscopic resection. Dig Endosc 2018; 30: 624-632
5 Choi YK, Ahn JY, Kim DH. et al. Efficacy and safety of endoscopic submucosal dissection for gastric neoplasms in patients with compensated liver cirrhosis: a propensity score-matched case-control study. Gastrointest Endosc 2018; 87
6 Ono H, Yao K, Fujishiro M. et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Digest Endosc 2015; 28: 3-15
7 Kondo A, De Moura EG, Bernardo WM. et al. Endoscopy VS Surgery in the treatment of early gastric cancer: Systematic review. World J Gastroenterol 2015; 21: 13177-13187
8 Goh PG, Jeong HY, Kim MJ. et al. Clinical outcomes of endoscopic submucosal dissection for undifferentiated or submucosal invasive early gastric cancer. Clin Endosc 2011; 44: 116-122
9 Han JS, Jang JS, Choi SR. et al. A study of metachronous cancer after endoscopic resection of early gastric cancer. Scandinavian J Gastroenterol 2011; 46: 1099-1104
10 Lee JY, Cho KB, Kim ES. et al. Risk factors for local recurrence after en bloc endoscopic submucosal dissection for early gastric cancer. World J Gastrointest Endosc 2016; 8: 330-337
11 Libanio D, Pimentel-Nunes P, Afonso LP. et al. Long-term outcomes of gastric endoscopic submucosal dissection: focus on metachronous and non-curative resection management. GE Port J Gastroenterol 2017; 24: 31-39
12 Min BH, Kim ER, Kim KM. et al. Surveillance strategy based on the incidence and patterns of recurrence after curative endoscopic submucosal dissection for early gastric cancer. Endoscopy 2015; 47: 784-793
13 Shindo Y, Matsumoto S, Miyatani H. Risk factors for postoperative bleeding after gastric endoscopic submucosal dissection in patients under antithrombotics. World J Gastrointest Endosc 2016; 8: 349-356
14 Nobre MRC, Bernardo WM, Jatene FB. The clinical practice based on evidence. Part I - Constructed clinical issues. Rev Assoc Med Bras 2003; 49: 445-449
15 The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
16 Ono H, Yao K, Fujishiro M. et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Digest Endosc 2015; 28: 3
17 WHO. The Asia-pacific Perspective: Redefining Obesity and Its treatment. Sydney: Health Communications Australia; 2000
18 Choi IJ, Lee NR, Kim SG. et al. Short-term outcomes of endoscopic submucosal dissection in patients with early gastric cancer: a prospective multicenter cohort study. Gut Liver 2016; 10: 739-748
19 Ministry of Health, Labour and Welfare. Comparison of the average life span. Avaiable from: http://www.mhlw.go.jp/english/wp/wp-hw9/dl/01e.pdf
20 Iwai N, Dohi O, Naito Y. et al. Impact of the Charlson comorbidity index and prognostic nutritional index on prognosis in patients with early gastric cancer after endoscopic submucosal dissection. Digest Endosc 2018; 30: 616-623
21 Katsube T, Murayama M, Yamaguchi K. et al. Additional surgery after non-curative resection of esd for early gastric cancer. Anticancer Res 2015; 35: 2969-2974
22 Kato M, Michida T, Kusakabe A. et al. Safety and short-term outcomes of endoscopic submucosal dissection for early gastric cancer in elderly patients. Endosc Int Open 2016; 04: E521-E526
23 Isomoto H, Ohnita K, Yamaguchi N. et al. Clinical outcomes of endoscopic submucosal dissection in elderly patients with early gastric cancer. Europ J Gastroenterol Hepatol 2010; 22: 311-317
24 Toyokawa T, Fujita I, Morikawa T. et al. Clinical outcomes of ESD for early gastric neoplasms in elderly patients. Eur J Clin Invest 2011; 41: 474-478
25 Yang HJ, Kim SG, Lim JH. et al. Novel risk stratification for metachronous recurrence after curative endoscopic submucosal dissection for early gastric cancer. Gastrointest Endosc 2018; 87: 419-428
26 Zhang Y, Huang L, Li L. Endoscopic submucosal dissection for early gastric neoplasms in elderly patients. J Laparoendosc Advanced Surgl Tech 2014; 24: 391-398
27 Nam HS, Choi CH, Kim SJ. et al. Endoscopic predictive factors associated with local recurrence after gastric endoscopic submucosal dissection. Scandinavian J Gastroenterol 2018; 1484153
28 Lin J, Zhang Y, Xue M. et al. Endoscopic submucosal dissection for early gastric cancer in elderly patients: a meta-analysis. World J Surg Oncology 2015; 13: 293
29 Sumiyoshi T, Kondo H, Fujii R. Short- and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in elderly patients aged 75 years and older. Gastric Cancer 2017; 20: 489-495
30 Gotoda T, Yanagisawa A, Sasako M. et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 2000; 3: 219-225
31 Goto A, Nishikawa J, Hideura E. et al. Lymph node metastasis can be determined by justtum or depth and lymphovascular invasion in early gastric cancer patients after endoscopic submucosal dissection. Europ J Gastroenterol Hepatol 2017; 29: 1346-1350
32 Nakanishi H, Kurosaki M, Takahashi Y. et al. Pretreatment gastric lavage reduces postoperative bleeding after endoscopic submucosal dissection for gastric neoplasms. PLoS ONE 2016; 11: e0149235
33 Park CH, Kim EH, Kang JH. et al. Low incidence of synchronous or metachronous tumors after endoscopic submucosal dissection for early gastric cancer with undifferentiated histology. PLoS ONE 2016; 11: e0147874
34 Jeon HK, Lee SJ, Kim GH. et al. Endoscopic submucosal dissection for undifferentiated-type early gastric cancer: short- and long-term outcomes. Surg Endoscopy 2018; 32: 1963-1970
35 Zhao X, Cai A, Xi H. et al. Predictive factors for lymph node metastasis in early gastric cancer with signet ring cell histology: a meta-analysis. ANZ J Surg 2017; 87: 981-986
36 Horiuchi Y, Fujisaki J, Yamamoto N. et al. Mixed poorly differentiated adenocarcinoma in undifferentiated? type early gastric cancer predicts endoscopic noncurative resection. Gastric Cancer 2018; 21: 689-695
37 Horiuchi Y, Fujisaki J, Yamamoto N. et al. Undifferentiated-type component mixed with differentiated-type early gastric cancer is a significant risk factor for endoscopic non-curative resection. Digest Endosc 2018; 30: 624-632
38 Han JP, Hong SJ, Kim HK. et al. Long-term outcomes of early gastric cancer diagnosed as mixed adenocarcinoma after endoscopic submucosal dissection. J Gastroenterol Hepatol 2015; 30: 316-320
39 Bang CS, Ho Baik G. Endoscopic submucosal dissection for early gastric cancer with undifferentiated-type histology: A meta-analysis. World J Gastroenterol 2015; 21: 6032-6043
40 Yoon JY, Shim CN, Chung SH. et al. Impact of tumor location on clinical outcomes of gastric endoscopic submucosal dissection. World J Gastroenterol 2014; 20: 8631-8637
41 Kim EH, Park JC, Song IJ. et al. Prediction model for non-curative resection of endoscopic submucosal dissection in patients with early gastric cancer. Gastrointest Endosc 2017; 85: 976-983
42 Toyakawa T, Inaba T, Omote S. et al. Risk factors for non-curative resection of early gastric neoplasms with endoscopic submucosal dissection: Analysis of 1,123 lesions. Experiment Therap Med 2015; 9: 1209-1214
43 Horiuchi Y, Fujisaki J, Yamamoto N. et al. Diagnostic accuracy demarcation using magnifying endoscopy with narrow? band imaging for Helicobacter pylori uninfected undifferentiated type early gastric cancer. Gastric Cancer 2018; 21: 988-997
44 Kang D, Ha SE, Park JM. et al. Body mass index and clinical outcomes from endoscopic submucosal dissection of gastric neoplasia. Dig Dis Sci 2017; 62: 1657-1665
45 Abe S, Oda I, Suziki H. et al. Long-term surveillance and treatment outcomes of metachronous gastric cancer occurring after curative endoscopic submucosal dissection. 2015; 47: 1113-1118
46 Jung S, Park CH, Kim EH. et al. Preventing metachronous gastric lesions after endoscopic submucosal dissection through Helicobacter pylori eradication. J Gastroenterol Hepatol 2015; 30: 75-81
47 Machata Y, Nakamura S, Fujisawa K. et al. Long-term effect of Helicobacter pylori eradication on the development of metachronous gastric cancer after endoscopic resection of early gastric cancer. Gastrointest Endosc 2012; 75: 39-46
48 Sugimoto T, Yamaji Y, Sakitani K. et al. Neutrophil infiltration and the distribution f intestinal metaplasia is associated with metachronous gastric cancer following endoscopic submucosal dissection. Can J Gastroenterol Hepatol 2015; 29: 321-325
49 Han SJ, Kim SG, Lim JH. et al. Long-term effects of helicobacter pylori eradication on metachronous gastric cancer development. Gut Liver 2018; 12: 133-141
50 Chung CS, Who HS, Chung JW. et al. Risk factors for metachronous recurrence after endoscopic submucosal dissection of early gastric cancer. J Korean Med Sci 2017; 32: 421-426
51 Wong BC, Lam SK, Wong WM. et al. Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. JAMA 2004; 291: 187-194
52 Kim SB, Lee SH, Bae SI. et al. Association between Helicobacter pylori status and metachronous gastric cancer after endoscopic resection. World J Gastroenterol 2016; 22: 9794-9802
53 Jung DH, Kim JH, Lee YC. et al. Helicobacter pylori eradication reduces the metachronous recurrence of gastric neoplasms by attenuating the precancerous process. J Gastric Cancer 2015; 15: 246-255
54 Xiao S, Li S, Zhou S. et al. Helicobacter pylori status and risks of metachronous recurrence after endoscopic resection of early gastric cancer: a systematic review and meta-analysis. J Gastroenterol 2019; 54: 226-237
55 Iguchi M, Kato J, Yoshida T. et al. Serum pepsinogen levels can quantify the risk of development of metachronous gastric cancer after endoscopic resection. Int J Cancer 2016; 139: 1150-1156
56 Kwon Y, Jeon S, Nam S. et al. Helicobacter pylori infection and serum level of pepsinogen are associated with the risk of metachronous gastric neoplasm after endoscopic resection. Aliment Pharmacol Ther 2017; 46: 758-767
57 Hamilton SR, Aaltonen LA. Pathology and genetics of tumours of the digestive system. Lyon: IARC press; 2000
58 Schlemper RJ, Riddell RH, Kato Y. et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255

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