Endoscopy 2022; 54(09): 892-901
DOI: 10.1055/a-1724-7378
Systematic review

Risk factors for gastric metachronous lesions after endoscopic or surgical resection: a systematic review and meta-analysis

1   Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
,
Gonçalo Figueirôa
2   Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
,
3   Department of Medical and Surgical Sciences, Gastroenterology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
4   IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
,
Pedro Pimentel-Nunes
1   Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
5   CINTESIS (Center for Health Technology and Services Research), Faculty of Medicine, University of Porto, Porto, Portugal
,
Cesare Hassan
6   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
7   Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
,
Mário Dinis-Ribeiro
1   Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
5   CINTESIS (Center for Health Technology and Services Research), Faculty of Medicine, University of Porto, Porto, Portugal
,
3   Department of Medical and Surgical Sciences, Gastroenterology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
4   IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
,
1   Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
5   CINTESIS (Center for Health Technology and Services Research), Faculty of Medicine, University of Porto, Porto, Portugal
› Institutsangaben

Abstract

Introduction Metachronous gastric lesions (MGL) are a significant concern after both endoscopic and surgical resection for early gastric cancer. Identification of risk factors for MGL could help to individualize surveillance schedules and potentially reduce the burden of care, but data are inconclusive. We aimed to identify risk factors for MGL and compare the incidence after endoscopic resection (ER) and subtotal gastrectomy.

Methods We conducted a systematic review by searching PubMed, ISI, and Scopus, and performed meta-analysis.

Results 52 studies were included. Pooled cumulative MGL incidence after ER was 9.3 % (95 % confidence interval [CI] 7.7 % to 11.0 %), significantly higher than after subtotal gastrectomy (1.2 %, 95 %CI 0.5 % to 2.2 %). After adjusting for mean follow-up, predicted MGL at 5 years was 9.5 % after ER and 0.7 % after subtotal gastrectomy. Older age (mean difference 1.08 years, 95 %CI 0.21 to 1.96), male sex (odds ratio [OR] 1.43, 95 %CI 1.22 to 1.66), family history of gastric cancer (OR 1.88, 95 %CI 1.03 to 3.41), synchronous lesions (OR 1.72, 95 %CI 1.30 to 2.28), severe gastric mucosal atrophy (OR 2.77, 95 %CI 1.22 to 6.29), intestinal metaplasia in corpus (OR 3.15, 95 %CI 1.67 to 5.96), persistent Helicobacter pylori infection (OR 2.08, 95 %CI 1.60 to 2.72), and lower pepsinogen I/II ratio (mean difference –0.54, 95 %CI –0.86 to –0.22) were significantly associated with MGL after ER. Index lesion characteristics were not significantly associated with MGL. ER treatment was possible in 83.2 % of 914 MGLs (95 %CI 72.2 to 91.9 %).

Conclusion Follow-up schedules should be different after ER and subtotal gastrectomy, and individualized further based on diverse risk factors.

Tables 1s–3s, Figs. 1s–4s



Publikationsverlauf

Eingereicht: 21. Juni 2021

Angenommen: 29. November 2021

Artikel online veröffentlicht:
01. Februar 2022

© 2022. Thieme. All rights reserved.

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Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Ferlay J, Soerjomataram I, Dikshit R. et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136: E359-E386
  • 2 Suh M, Choi KS, Park B. et al. Trends in cancer screening rates among Korean men and women: results of the Korean National Cancer Screening Survey, 2004–2013. Cancer Res Treat 2016; 48: 1-10
  • 3 Abdelfatah MM, Barakat M, Ahmad D. et al. Long-term outcomes of endoscopic submucosal dissection versus surgery in early gastric cancer: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2019; 31: 418-424
  • 4 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854
  • 5 Libanio D, Braga V, Ferraz S. et al. Prospective comparative study of endoscopic submucosal dissection and gastrectomy for early neoplastic lesions including patients’ perspectives. Endoscopy 2019; 51: 30-39
  • 6 Lim JH, Kim J, Kim SG. et al. Long-term clinical outcomes of endoscopic vs. surgical resection for early gastric cancer with undifferentiated histology. Surg Endosc 2019; 33: 3589-3599
  • 7 Nozaki I, Nasu J, Kubo Y. et al. Risk factors for metachronous gastric cancer in the remnant stomach after early cancer surgery. World J Surg 2010; 34: 1548-1554
  • 8 Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 2021; 24: 1-21
  • 9 Cho CJ, Ahn JY, Jung HY. et al. The incidence and locational predilection of metachronous tumors after endoscopic resection of high-grade dysplasia and early gastric cancer. Surg Endosc 2016; 31: 389-397
  • 10 Abe S, Oda I, Suzuki H. et al. Long-term surveillance and treatment outcomes of metachronous gastric cancer occurring after curative endoscopic submucosal dissection. Endoscopy 2015; 47: 1113-1118
  • 11 Pimentel-Nunes P, Libanio D, Marcos-Pinto R. et al. Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy 2019; 51: 365-388
  • 12 Han JS, Jang JS, Choi SR. et al. A study of metachronous cancer after endoscopic resection of early gastric cancer. Scand J Gastroenterol 2011; 46: 1099-1104
  • 13 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
  • 14 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700
  • 15 Toyoshima O, Nishizawa T, Koike K. Endoscopic Kyoto classification of Helicobacter pylori infection and gastric cancer risk diagnosis. World J Gastroenterol 2020; 26: 466-477
  • 16 Balshem H, Helfand M, Schunemann HJ. et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011; 64: 401-406
  • 17 Chung CS, Woo 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
  • 18 Yang HJ, Kim SG, Lim JH. et al. Surveillance strategy according to age after endoscopic resection of early gastric cancer. Surg Endosc 2017; 32: 846-854
  • 19 Nakata R, Nagami Y, Hashimoto A. et al. Successful eradication of Helicobacter pylori could prevent metachronous gastric cancer: a propensity matching analysis. Digestion 2021; 102: 236-245
  • 20 Lee HJ, Lee YJ, Lee JY. et al. Characteristics of synchronous and metachronous multiple gastric tumors after endoscopic submucosal dissection of early gastric neoplasm. Clin Endosc 2018; 51: 266-273
  • 21 Chung H, Kim HJ, Jung HC. et al. Statins and metachronous recurrence after endoscopic resection of early gastric cancer: a nationwide Korean cohort study. Gastric Cancer 2020; 23: 659-666
  • 22 Fukase K, Kato M, Kikuchi S. et al. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet 2008; 372: 392-397
  • 23 Sugimoto T, Yamaji Y, Sakitani K. et al. Neutrophil infiltration and the distribution of intestinal metaplasia is associated with metachronous gastric cancer following endoscopic submucosal dissection. Can J Gastroenterol Hepatol 2015; 29: 321-325
  • 24 Asada K, Nakajima T, Shimazu T. et al. Demonstration of the usefulness of epigenetic cancer risk prediction by a multicentre prospective cohort study. Gut 2014; 64: 388-396
  • 25 Sakuta K, Sasaki Y, Abe Y. et al. Somatic alterations and mutational burden are potential predictive factors for metachronous development of early gastric cancer. Sci Rep 2020; 10: 22071
  • 26 Morgagni P, Gardini A, Marrelli D. et al. Gastric stump carcinoma after distal subtotal gastrectomy for early gastric cancer: experience of 541 patients with long-term follow-up. Am J Surg 2014; 209: 1063-1068
  • 27 Smyth EC, Verheij M, Allum W. et al. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27: v38-v49
  • 28 Ajani JA, D’Amico TA, Almhanna K. et al. Gastric cancer, Version 3.2016, NCCN Clinical Practice Guidelines in oncology. J Natl Compr Canc Netw 2016; 14: 1286-1312
  • 29 Figueiroa G, Pimentel-Nunes P, Dinis-Ribeiro M. et al. Gastric endoscopic submucosal dissection: a systematic review and meta-analysis on risk factors for poor short-term outcomes. Eur J Gastroenterol Hepatol 2019; 31: 1234-1246
  • 30 Leung WK, Yu J, Ng EK. et al. Concurrent hypermethylation of multiple tumor-related genes in gastric carcinoma and adjacent normal tissues. Cancer 2001; 91: 2294-2301
  • 31 Miyoshi E, Haruma K, Hiyama T. et al. Microsatellite instability is a genetic marker for the development of multiple gastric cancers. Int J Cancer 2001; 95: 350-353
  • 32 Kapadia CR. Gastric atrophy, metaplasia, and dysplasia: a clinical perspective. J Clin Gastroenterol 2003; 36: S29-36 discussion S61-2
  • 33 Zhao B, Zhang J, Mei D. et al. Does Helicobacter pylori eradication reduce the incidence of metachronous gastric cancer after curative endoscopic resection of early gastric cancer: a systematic review and meta-analysis. J Clin Gastroenterol 2020; 54: 235-241
  • 34 Ford AC, Yuan Y, Moayyedi P. Helicobacter pylori eradication therapy to prevent gastric cancer: systematic review and meta-analysis. Gut 2020; 69: 2113-2121
  • 35 Bang CS, Baik GH, Shin IS. et al. Helicobacter pylori eradication for prevention of metachronous recurrence after endoscopic resection of early gastric cancer. J Korean Med Sci 2015; 30: 749-756