RISK FACTORS FOR NON-CURATIVE ENDOSCOPIC RESECTION OF EARLY GASTRIC CANCER

Aims Early gastric cancer (EGC) is defined as adenocarcinoma that invades no more deeply than the submucosa irrespective of lymph node metastasis (LNM). In selected cases of EGC with very low risk of LNM endoscopic submucosal dissection (ESD) can be curative. However, in 20% of cases there are pathological features other than the standard and expanded criteria that may lead to non-curative resection (NCR).

Aims To identify the pre-treatment risk factors for NCR curability that may improve selecting cases for ESD.

Methods Single center retrospective cohort of consecutive patients with EGC that underwent ESD (2005 – 2020). Collected data was compared between 2 groups: curative vs NCR with risk of LNM. Univariate and multivariate analysis was performed.

Results 668 lesions underwent ESD for EGC, of which 82 (12%) presented NCR with risk of LNM and 586 lesions were assigned to the Curative group.

Mean age,%male sex,%en bloc ESD and mean size were 66.9, 57.3%, 97.1% and 18.95mm in the Curative Group and 68.5, 72%, 93.9%, 27.29mm in the NCR Group.

The identified risk factors were related to location, size, presence of ulceration, histology on previous endoscopic biopsies and morphology of the lesion (Table, multivariate).

Male sex was associated with NCR on univariate but not on multivariate analysis.

Table 1

	Non-curative	Curative	P value	Adjusted OR (95% CI)
Location	13(13.5%)	83(86.5%)	0.189	1.74(0.76–3.40)
Upper third	42(18.1%)	190(81.9%)	0.007	2.33(1.26–4.31)
Middle	27(7.9%)	313(92.1%)		1
Lower
Size
0–20mm	29(6.3%)	429(93.7%)		1
21–30mm	36(24.3%)	112(75.7%)	0.001	2.69(1.48–4.89)
>=31mm	17(27.4%)	45(72.6%)	<0.001	4.60(2.14–9.85)
Ulceration
Present	14(37.8%)	23(62.2%)	0.018	2.80(1.19–6.55)
Absent	67(11.9%)	494(88.1%)		1
Previous Histology
LGD	5(2.0%)	251(98.0%)		1
HGD	29(12.1%)	210(87.9%)	<0.001	6.12(2.24–16.70)
Carcinoma	47(32.4%)	98(67.6%)	<0.001	14.99(5.50–40.84)
Morphology
Depressed	53(17.0%)	258(83.0%)	0.049	1.99(1.00–3.95)
Protruded	13(18.1%)	59(81.9%)	0.042	2.53(1.03–6.19)
Flat	16(5.7%)	267(94.3%)		1

Conclusions Middle gastric location, size>20mm, presence of ulceration, HGD or Carcinoma in endoscopic biopsies on previous biopsies and protruded or depressed morphology are risk factors for NCR.

Publication History

Article published online:
14 April 2022