Clinico-pathologic determinants of non-e-curative outcomes following en-bloc endoscopic submucosal dissection in patients with early gastric neoplasia

Abstract

BackgroundEndoscopic submucosal dissection (ESD) is gaining enormous popularity in the treatment of early gastric cancers (EGCs) across many institutions in the world. However, appropriate selection of patients for endoscopic resection is crucial to sufficiently mitigate non-e-curative (NEC) resection. This study aims at identifying the various clinico-pathologic factors that independently predict the depth of submucosal invasion and NEC resection following ESD in patients with EGCs.MethodsMultiple logistic regression analysis was applied to investigate factors that independently predict the level of submucosal invasion and NEC resection in patients with early gastric neoplasia. Statistical Packages for the Social Sciences version 23 was used for analysis.ResultsA total of 162 EGCs underwent en-bloc ESD for which the rate of complete resection and non-e-curative outcomes were 95% and 22.2%, correspondingly. Multivariate analysis depicted that tumor location in the upper two third of stomach (odds ratio [OR] 5.46, confidence interval [CI] 95%, 1.65-18.12, p = 0.006), tumor size > 2 cm (OR 7.63, CI 95%, 2.29-25.42, p = 0.001), histologically undifferentiated tumor (OR 15.54, CI 95%, 1.65-146.22, p = 0.001), and tumors with 0-IIa/0-IIc or their mixed variants with predominant 0-IIa/0-IIc (OR 9.77, CI 95%, 1.23-77.65, p = 0.031) were all independent predictors of NEC resection for early gastric tumors. Additionally, location in the upper two third of stomach (OR 8.88, CI 95%, 2.90-27.17, p < 0.001), ulcerated lesions (OR 3.70, CI 95%, 1.15-11.90, p = 0.028), lesions with > 2 cm (OR 2.94, CI 95%, 1.08-8.02, p = 0.036) and those with poor differentiation (OR 6.51, CI 95%, 2.23-18.98, p = 0.001) were found to have significant association with submucosal invasion.ConclusionsTumors located in the upper two third of stomach having larger size (> 2 cm), poor histo-differentiation and a gross type of 0-IIa/0-IIc or their mixed variants with predominant 0-IIa/0-IIc are significantly associated with a risk of NEC after ESD procedure. Thus, early gastric tumors displaying these features need to be handled carefully during endoscopic resection. Our findings may provide some insights about the factors that determine non-curability in patients with EGC in relation to ESD procedure.