Predictive Factors for Short-Term Survival after Non-Curative Endoscopic Submucosal Dissection for Early Gastric Cancer

Shimada, Tomohiro; Yamagata, Taku; Kanno, Yoshihide; Ohira, Tetsuya; Harada, Yoshihiro; Koike, Yoshiki; Tanaka, Megumi; Komabayashi, Daichi; Shimizu, Takeshi; Suzuki, Shohei; Ito, Kei

doi:10.1159/000510165

Cited by 14 publications

(23 citation statements)

References 43 publications

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“…Furthermore, after neoadjuvant therapy, 95.4% and 78.9% overall survival were recorded for stages I/II and III/IV ( 48 ), respectively. Comorbidities were also associated with an increased risk of death in patients with gastric cancer ( 10 ), and a CCI score ≥3 was associated with lower overall survival, supporting previous studies ( 11 , 49 ). This result confirmed that comorbidities exist at gastric adenocarcinoma diagnosis and that the type and severity of the comorbidity are important for therapeutic planning.…”

Section: Discussionsupporting

confidence: 82%

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Gastric adenocarcinoma: 1-year overall survival, disability-adjusted life years, years of life lost, and prognostic factors—a single-institution experience

Tiengo

Fernandes²,

Curado³

2022

Front. Oncol.

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ObjectiveTo analyze factors affecting 1-year overall survival and burden of gastric adenocarcinoma in a single-institution cohort.MethodsA prospective cohort study of gastric adenocarcinoma patients from a cancer center in São Paulo, Brazil, was conducted between February 2016 and July 2019. Overall survival was analyzed at 12 months post-diagnosis using the Kaplan–Meier method. A log-rank test was applied to compare curves. Sociodemographic and clinicopathological features were assessed to detect prognostic factors using univariate and multivariable Cox regression analyses to calculate hazard ratio (HR) and its confidence intervals (CIs). Disability-adjusted life years (DALY) constituted the sum of years of life lost (YLL) plus years lived with disability (YLD). YLL represented the sum of years lost before the age of 76.6 years. YLD was calculated as the number of cases multiplied by the duration and burden of the disease. YLL per death was calculated as the mean YLL for each individual.ResultsOverall survival at 1-year follow-up was 80.8%. The multivariable model adjusted for age and sex identified cerebrovascular disease (HR 8.5, 95% CI 3.3–21.8), stage III/IV (HR 5.7, 95% CI 2.3–13.7), diabetes (HR 3.2, 95% CI 1.5–6.6), and<9 years of education (HR 2.9, 95% CI 1.5–5.8) as prognostic factors. Out of the 214 treated cases, there was 700.72 DALY during the first year, of which 90.55% corresponded to YLL and 9.45% to YLD. The average YLL per death was 15.48 and was higher among women (19.24 YLL per death).ConclusionAt a single cancer center, 1-year overall survival probability was approximately 80% in patients with gastric adenocarcinoma. Patients with a higher risk of death had cerebrovascular disease, advanced clinical staging, diabetes, and/or lower educational level. Approximately 700 years of DALY was documented, with women having the highest YLL per death. Because this study was conducted at a single cancer center, the results might not be representative of a general population. To the best of our knowledge, this study was the first to assess gastric adenocarcinoma DALY, YLL, and YLL per death in the first year of follow-up in a hospital cohort in Brazil.

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Section: Discussionsupporting

confidence: 82%

“…In our study, diabetes and cerebrovascular disease impacted prognosis. According to Shimada et al (2020), patients who died by the first year of follow-up had a higher rate of cerebrovascular diseases before cancer diagnosis ( 49 ). This relationship was corroborated by the findings of the current study.…”

Section: Discussionmentioning

confidence: 99%

Gastric adenocarcinoma: 1-year overall survival, disability-adjusted life years, years of life lost, and prognostic factors—a single-institution experience

Tiengo

Fernandes²,

Curado³

2022

Front. Oncol.

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“…Finally, we developed the risk classification for non‐gastric cancer‐related early and late mortality to compare the risk for gastric and non‐gastric cancer‐related mortality. Previous reports regarding upper gastrointestinal cancers set the cut‐off of early and late mortality as 3 years 14,15 . According to previous reports, about 50% of mortality occurred within 3 years after the treatment for EGC 16,17 .…”

Section: Methodsmentioning

confidence: 99%

“…Previous reports regarding upper gastrointestinal cancers set the cut-off of early and late mortality as 3 years. 14,15 According to previous reports, about 50% of mortality occurred within 3 years after the treatment for EGC. 16,17 Additionally, 3 years is one of the major indicators for the long-term prognosis in studies about gastric cancer; [18][19][20][21] thus, it might be significant to evaluate predictors for mortality before and after 3 years, separately.…”

Section: Outcome Measuresmentioning

confidence: 99%

Predictors of early and late mortality after the treatment for early gastric cancers

Ogata

Hatta

Ohara

et al. 2021

Digestive Endoscopy

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Objectives Although many patients with early gastric cancers (EGCs) die of non‐gastric cancer‐related causes, the association of the risk categories of lymph node metastasis (LNM) with all‐cause mortality remains unclear. We aimed to clarify the predictors of early and late mortality, separately. Methods Patients with endoscopic resection or gastrectomy for EGCs between 2003 and 2017 were retrospectively enrolled. We analyzed predictors for early and late mortality, including risk categories of LNM, treatment method, and nine non‐cancer‐related indices, separately, with a cut‐off value of 3 years. Results We enrolled 1439 patients with a median follow‐up period of 79 months. The 5‐year overall survival rate was 86.8%. In the multivariate Cox analysis, the most important predictors for early and late mortality were age ≥85 years (hazard ratio [HR] 2.88 and 4.54, respectively) and Eastern Cooperative Oncology Group Performance Status ≥2 (HR 3.00 and 4.19, respectively). Charlson comorbidity index ≥2 (HR 2.76 and 1.99, respectively), American Society of Anesthesiologists Physical Status ≥3 (HR 2.35 and 1.79, respectively), and C‐reactive protein/albumin ratio ≥0.028 (HR 2.30 and 1.58, respectively) were also predictors for both early and late mortality. Male (HR 2.26), intermediate‐ (HR 2.12)/high‐risk (HR 1.85) of LNM in eCura system, and sarcopenia evaluated by the psoas muscle mass index (HR 1.70) were predictors for early mortality. Conclusion The combined assessment of multiple predictors might help to predict early and/or late mortality in patients with EGCs. The eCura system was associated with early mortality.

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“…They concluded that the indication of ESD should be reconsidered in elderlies with low prognostic nutritional index. The Charlson comorbidity index, which is also a risk score considering comorbid conditions, appears to be useful to predict mortality after ESD, particularly in patients who underwent noncurative ESD [28][29][30].…”

Section: No Surgery No Prognosis After Noncurative Esd?mentioning

confidence: 99%

What’s New with Endoscopic Treatments for Early Gastric Cancer in the “Post-ESD Era”?

2021

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Background: Endoscopic treatments for gastric cancers have still been progressing even after the great success of endoscopic submucosal dissection (ESD). Summary: In further advancements of ESD, safe and less-invasive procedures are challenged by managing postoperative bleeding, one of the major adverse events in ESD. Covering the mucosal defect after removal of lesions appears reasonable and effective for preventing delayed bleeding from the post-ESD ulcers. Shielding with biodegradable sheets is attempted on clinical trials, which show equivocal results. Although suturing of the mucosal rims is technically challenging, pilot studies demonstrate favorable outcomes for avoiding post-ESD bleeding even in cases at high risk. In cases after noncurative resection of ESD, the selection of patients who truly require additional gastrectomy with lymph node dissection is important to provide necessary surgery. Risk stratification of lymph node metastases and surgery has been developed, which offers tailor-made management to each patient considering the risks and benefits. In surgery, function-preserving gastrectomy to minimize the resection area in both lymphadenectomy and the primary site is clinically introduced. The sentinel node navigation surgery is promising to realize the minimally invasive gastrectomy, and it should strongly fit ESD as well as laparoscopic endoscopic cooperative surgery or endoscopic full-thickness resection, although nonexposure approaches are desirable. Key Message: Development for less-invasive managements on gastric cancer will be continued in step with the advancement of endoscopic treatments.

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Predictive Factors for Short-Term Survival after Non-Curative Endoscopic Submucosal Dissection for Early Gastric Cancer

Cited by 14 publications

References 43 publications

Gastric adenocarcinoma: 1-year overall survival, disability-adjusted life years, years of life lost, and prognostic factors—a single-institution experience

Gastric adenocarcinoma: 1-year overall survival, disability-adjusted life years, years of life lost, and prognostic factors—a single-institution experience

Predictors of early and late mortality after the treatment for early gastric cancers

What’s New with Endoscopic Treatments for Early Gastric Cancer in the “Post-ESD Era”?

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