Potential for expanding indications and curability criteria of endoscopic resection for early gastric cancer in elderly patients: results from a Japanese multicenter prospective cohort study - 24/08/24
, Haruhisa Suzuki, MD 2, Kohei Takizawa, MD, PhD 3, Toshiaki Hirasawa, MD 4, Yoji Takeuchi, MD, PhD 5, Kenji Ishido, MD, PhD 6, Shu Hoteya, MD, PhD 7, Tomonori Yano, MD, PhD 8, Shinji Tanaka, MD, PhD 9, Yosuke Toya, MD, PhD 10, Masahiro Nakagawa, MD, PhD 11, Takashi Toyonaga, MD, PhD 12, Kenichi Takemura, MD 13, Kingo Hirasawa, MD, PhD 14, Mitsuru Matsuda, MD, PhD 15, Hironori Yamamoto, MD, PhD 16, Yosuke Tsuji, MD, PhD 17, Satoru Hashimoto, MD, PhD 18, Yuki Maeda, MD 3, Tsuneo Oyama, MD, PhD 19, Ryuta Takenaka, MD, PhD 20, Yoshinobu Yamamoto, MD, PhD 21, Taichi Shimazu, MD, PhD 22, Hiroyuki Ono, MD, PhD 3, Satoshi Tanabe, MD, PhD 6, 23, Hitoshi Kondo, MD, PhD 24, Hiroyasu Iishi, MD, PhD 25, Motoki Ninomiya, MD, PhD 26, Ichiro Oda, MD 2, 27, ⁎ on behalf of the
J-WEB/EGC group
Abstract |
Background and Aims |
Evidence for endoscopic resection (ER) in elderly patients with early gastric cancer (EGC) is limited. We assessed its clinical outcomes and explored new indications and curability criteria.
Methods |
We analyzed data from a Japanese multicenter, prospective cohort study. Patients aged ≥75 years with EGC treated with ER were included. We classified eCuraC-2 (corresponding to noncurative ER, defined in the Japanese gastric cancer treatment guidelines) into elderly-high (>10% estimated metastatic risk) and elderly-low (EL-L) (≤10% estimated metastatic risk).
Results |
In total, 3371 patients with 3821 EGCs were included; endoscopic submucosal dissection was the prominent treatment choice. Among them, 3586 lesions met the guidelines’ ER indications, and 235 did not. The proportions of en bloc and R0 resections and perforations were 98.9%, 94.4%, and 0.8%, respectively, in EGCs within the indications. In EGCs beyond the indications, they were 99.5%, 85.4%, and 5.9%, respectively, for lesions diagnosed as ≤3 cm and 96.0%, 64.0%, and 18.0%, respectively, for those >3 cm. Curative ER and EL-L were observed in 83.6% and 6.2% of lesions within the indications, respectively, and in 44.2% and 16.8% of lesions <3 cm beyond the indications, respectively. The 5-year cumulative gastric cancer death rates after curative ER and elderly-high were 0.3% (95% confidence interval [CI], 0.2-0.6) and 3.5% (95% CI, 2.0-5.7), respectively. After EL-L, the rate was 0.9% (95% CI, 0.2-3.5) even without subsequent treatment.
Conclusions |
The usefulness of endoscopic submucosal dissection for elderly EGC patients was confirmed by their clinical outcomes. Lesions of ≤3 cm and EL-L emerged as new ER indication and curability criteria, respectively. (Clinical trial registration number: UMIN000005871.)
Le texte complet de cet article est disponible en PDF.Abbreviations : BMI, eCura, CI, EGC, EL-H, EL-L, ER, ESD, GC, HR, LNM, OS
Plan
Vol 100 - N° 3
P. 438 - septembre 2024 Retour au numéro
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