Endoscopic Prediction of Tumor Invasion Depth in Early Gastric Signet Ring Cell Carcinoma

Kang, Sun Hyung; Moon, Hee Seok; Sung, Jae Kyu; Kim, Sae Hee; Kim, Ki Bae; Youn, Sei Jin; Kim, Sun Moon; Song, Kyung Ho; Lee, Seung Woo; Lee, Dong Hoon; Cho, Young Sin; Chung, In Kwon; Bang, Ki Bae

doi:10.1159/000494277

Cited by 7 publications

(1 citation statement)

References 14 publications

(24 reference statements)

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“…Through logical regression analysis, Kang et al. ( 24 ) revealed that scar deformity, nodular surface appearance, and surface depression tended to invade SM2 for early SRC (OR 3.4, 5.9, 6.0; p < 0.05). For UD EGC patients with non-curative ESD, Jie-Hyun Kim et al.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and risk factors of non-curative endoscopic submucosal dissection for early gastric cancer: a retrospective multicenter study in Zhejiang, China

Jin,

Zhao,

Ding

et al. 2023

Front. Oncol.

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BackgroundEndoscopic submucosal dissection (ESD) for early gastric cancer (EGC) does not always lead to curative resection. Risk factors of lymph node metastasis (LNM)/local cancer residue after non-curative ESD for EGC have not been fully elucidated. We therefore aimed to clarify them and evaluate whether the “eCura system” is reliable for the risk stratification of LNM after non-curative ESD.MethodsWe conducted a multicenter retrospective study at seven institutions in Zhejiang, China, on 128 patients who underwent non-curative ESD for EGC. We divided the patients into two groups according to their therapeutic regimen after non-curative ESD. We analyzed the risk factors for LNM, local cancer residue, cancer recurrence, and cancer-specific mortality. Furthermore, we compared the outcomes in each risk category after applying the “eCura system”.ResultsAmong 68 patients undergoing additional surgery, LNM was found in three (4.41%) patients, while local cancer residue was found in eight (11.76%) patients. Multivariate analysis showed that upper third location and deep submucosal invasion were independent risk factors of LNM and local cancer residue. Among 60 patients who underwent simple follow-up, local cancer recurrence was found in four (6.67%) patients and cancer-specific mortality was found in one (1.67%) patient. There were no independent risk factors of cancer recurrence and cancer-specific mortality in our study. During the follow-up period, 5-year overall survival (OS) and disease-free survival (DFS) were 93.8% and 88.9%, respectively. Additionally, LNM and cancer recurrence were significantly associated with the eCura scoring system (p = 0.044 and p = 0.017, respectively), while local cancer residue and cancer-specific mortality were not (p = 0.478 and p = 0.131, respectively).ConclusionClinicians should be aware of the risk factors for the prognosis of patients with non-curative ESD to determine subsequent treatment. Through the application of the “eCura system”, additional surgery should be performed in patients with intermediate/high risk of LNM.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes and risk factors of non-curative endoscopic submucosal dissection for early gastric cancer: a retrospective multicenter study in Zhejiang, China

Jin,

Zhao,

Ding

et al. 2023

Front. Oncol.

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Expert assessment of infiltration depth and recommendation of endoscopic resection technique in early Barrett cancer

Younis,

Rösch,

Beyna

et al. 2024

UEG Journal

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BackgroundEarly Barrett cancer can be curatively treated by endoscopic resection. The choice of the resection technique, however—endoscopic mucosal resection (EMR) or submucosal dissection (ESD)—largely depends on the assumed infiltration depth as judged by the endoscopist. However, the accuracy of endoscopic diagnosis of the degree of cancer infiltration is not known.MethodsThree to four high‐quality images (both in overview and close‐up) from 202 of early Barrett esophagus cancer cases (82% men, mean age 66.9 years) were selected from our endoscopy database (73.3% stage T1a and 26.7% in stage T1b). Images were shown to 9 Barrett esophagus experts, with patients' clinical data (age, sex, Barrett esophagus length) and biopsy results. The experts were asked to predict infiltration depth (T1b vs. T1a), and to suggest the appropriate endoscopic resection technique (EMR or ESD, or surgery). Interobserver variability (kappa values) was also determined for these parameters.ResultsOverall positive (PPV) and negative predictive values (NPV) to diagnose T1b versus T1a infiltration were 40.7% (95% CI: 36.7, 44.8) and 79.8% (95% CI: 77.5, 81.9), respectively; kappa value was 0.41. Paris classification (kappa 0.51) and suggested treatment also varied between experts. In a post hoc analysis, only the correlation between lesions classified as invisible or flat according to the Paris classification (IIB; 25% of all cases) and the suggested resection technique was better: In this subgroup, EMR was recommended in >80% of cases, with a high complete (basal R0) resection rate (mean of 88.1%).ConclusionsPrecise endoscopic distinction between mucosal and submucosal involvement of Barrett esophagus cancer by experts as a basis for choosing the resection technique has limited predictive values and high interobserver variability. It seems that mainly invisible/flat lesions may result in good resection outcomes when treated by EMR, but this stratification strategy has to be assessed in further studies.

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Endoscopic and clinicopathologic features of early gastric signet ring cell carcinoma ≤20 mm: a retrospective observational study

Zhu

Lin

et al. 2022

Scandinavian Journal of Gastroenterology

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Endoscopic Prediction of Tumor Invasion Depth in Early Gastric Signet Ring Cell Carcinoma

Cited by 7 publications

References 14 publications

Clinical outcomes and risk factors of non-curative endoscopic submucosal dissection for early gastric cancer: a retrospective multicenter study in Zhejiang, China

Clinical outcomes and risk factors of non-curative endoscopic submucosal dissection for early gastric cancer: a retrospective multicenter study in Zhejiang, China

Expert assessment of infiltration depth and recommendation of endoscopic resection technique in early Barrett cancer

Endoscopic and clinicopathologic features of early gastric signet ring cell carcinoma ≤20 mm: a retrospective observational study

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