Koizumi E.a· Goto O.a· Takizawa K.b· Mitsunaga Y.c· Hoteya S.c· Hatta W.d· Masamune A.d· Osawa S.e· Takeuchi H.e· Suzuki S.f· Omori J.a· Ikeda G.a· Habu T.a· Ishikawa Y.a· Kirita K.a· Noda H.a· Higuchi K.a· Onda T.a· Akimoto T.a· Akimoto N.a· Kaise M.a· Iwakiri K.a

Author affiliations

aDepartment of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
bDivision of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
cDepartment of Gastroenterology, Toranomon Hospital, Tokyo, Japan
dDepartment of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
eDepartment of Photodynamic and Endoscopic Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
fDepartment of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan

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Article / Publication Details

First-Page Preview

Received: January 17, 2022
Accepted: March 06, 2022
Published online: May 05, 2022

Number of Print Pages: 12
Number of Figures: 5
Number of Tables: 4

ISSN: 0012-2823 (Print)
eISSN: 1421-9867 (Online)

For additional information: https://www.karger.com/DIG

Abstract

Background and Aims: Surgery is recommended in early gastric cancer (EGC) after noncurative endoscopic submucosal dissection (ESD), although observation can be an alternative. We aimed to develop a tailor-made treatment strategy for noncurative EGCs by comparing the lymph node metastasis risk (LNMR) and the surgical risk. Methods: We retrospectively identified 485 patients with differentiated-type, noncurative EGCs removed by ESD and classified them into two groups: a surgery-preferable group and an observation-preferable group, according to the clinical courses. Subsequently, LNMR and surgery-related death risk were assessed using a published scoring system and a risk calculator for gastrectomy, respectively. Finally, we investigated the optimal cutoff value of the risk difference (LNMR minus surgery-related death risk) to efficiently allocate these cases into either of two groups, surgery-preferable or observation-preferable. Results: In 485 patients (surgery in 322, observation in 163), 57 and 428 patients were classified into the surgery-preferable group and the observation-preferable group, respectively. The optimal cutoff value of the risk difference (LNMR minus surgery-related death risk) to allocate the cases to the two preferable groups was 7.85 with the highest area under the curve (0.689). When cases with >7.85 LNMR over the surgery-related death risk were allocated into the surgery-preferable group and vice versa, the discriminability was 73.2%, which was sufficiently higher than that in the clinical decision (44.5%). Conclusion: Personalized comparison of LNMR and surgery-related death risk is helpful to provide a favorable treatment option for each patient with EGCs after noncurative ESD.

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First-Page Preview

Received: January 17, 2022
Accepted: March 06, 2022
Published online: May 05, 2022

Number of Print Pages: 12
Number of Figures: 5
Number of Tables: 4

ISSN: 0012-2823 (Print)
eISSN: 1421-9867 (Online)

For additional information: https://www.karger.com/DIG

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