Prognosis after curative resection for stage IA gastric cancer in elderly patients: endoscopic submucosal dissection versus surgery

Miyahara, Koji; Ishida, Masaharu; Kono, Yoshiyasu; Hirata, Tetsu; Obayashi, Yuka; Gotoda, Tatsuhiro; Ninomiya, Yuki; Moritou, Yuki; Kitajima, Masaki; Choda, Yasuhiro; Shirakawa, Yasuhiro; Nakagawa, Masahiro; Okada, Hiroyuki

doi:10.1007/s00595-022-02456-0

Cited by 3 publications

(4 citation statements)

References 52 publications

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“…However, there is still no definitive difference between ESD treatment and surgical treatment for elderly patients with EGC. Some studies revealed that the OS between the ESD group and the surgery group was not significantly different [17][18][19][20]. Kishida Y et al conducted a study of 417 elderly patients (114 in the ESD group; 303 in the surgery group) and found that the ESD group had worse OS than the surgery group [16].…”

Section: Discussionmentioning

confidence: 99%

“…After the titles and abstracts of the remaining 183 studies were viewed, 14 studies were left for full-text screening. Eight studies were determined to be eligible and thereby included in this analysis [16][17][18][19][20][25][26][27] (Fig. 1).…”

Section: Study Selectionmentioning

confidence: 99%

“…A study reported that ESD was associated with worse overall survival (OS) [ 16 ]. Other studies showed that there was no significant difference in OS between ESD and surgery [ 17 – 20 ]. Therefore, the aim of this study was to investigate whether there is a difference in OS between the ESD and surgery.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of endoscopic submucosal dissection versus surgery for early gastric cancer in the elderly: a pooled analysis

Liu,

Wen,

Liu

et al. 2023

World J Surg Onc

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Purpose The aim of this study was to investigate whether there was a difference in overall survival (OS) between elderly patients with early gastric cancer (EGC) who underwent endoscopic submucosal dissection (ESD) and those who underwent surgery. Methods Four databases including PubMed, Embase, the Cochrane Library and CKNI were searched on March 20, 2023. The characteristics of the studies and the baseline information of the patients, including their medical histories, postoperative data, and prognoses, were recorded. Odds ratios (ORs) or mean differences (MDs), and 95% confidence intervals (CIs) were pooled up to calculate baseline information and postoperative information. Hazard ratios (HRs) and 95% CIs were used to calculate the prognosis of the patients. Stata V16.0 software was used for the data analysis. Results A total of eight studies involving 2334 patients were included for the data analysis in this study. After pooling up the data, we found that the ESD group had lower Eastern Cooperative Oncology Groupprevious (ECOG) scores (OR = 0.33, 95% CI = 0.17 to 0.65, I2 = 59.69%, P = 0.00 < 0.05) than the surgery group. There were significant differences in the operation time (MD = -3.38, 95% CI = -5.19 to -1.57, I2 = 98.31%, P = 0.00 < 0.05), length of hospital stay (MD = -3.01, 95% CI = -4.81 to -1.20, I2 = 98.83%, P = 0.00 < 0.05) and hospitalization expenses (MD = -2.67, 95% CI = -3.59 to -1.75, I2 = 93.21%, P = 0.00 < 0.05) between the two groups. The ESD group had a lower OS rate (HR = 2.81, 95% CI = 2.20 to 3.58, I2 = 12.28%, P = 0.00 < 0.05). Conclusion Elderly patients with EGC who underwent ESD had a significantly worse OS rate than those who underwent surgery. If the patient’s condition was suitable, surgery was still recommended for these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

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Comparison of endoscopic submucosal dissection versus surgery for early gastric cancer in the elderly: a pooled analysis

Liu,

Wen,

Liu

et al. 2023

World J Surg Onc

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“…These data suggest that most patients with non-curative ER for EGC died of non-gastric cancer-related causes, regardless of the treatment strategy after non-curative ER, and the difference in OS between additional and no additional treatment after non-curative ER may be largely due to the background characteristics of the patients. Many retrospective studies have investigated prognostic factors in patients with ER for EGC, and several prognostic indices, such as the American Society of Anesthesiologists’ physical status [ 88 , 89 ], prognostic nutrition index [ 90 ], and CCI [ 55 ], have been reported as being useful prognostic tools [ 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 ] ( Table 4 ). However, several issues have been raised regarding the interpretation of these results.…”

Section: Non-curative Er For Egcsmentioning

confidence: 99%

Management of Superficial Esophageal Squamous Cell Carcinoma and Early Gastric Cancer following Non-Curative Endoscopic Resection

Hatta

Koike

Uno

et al. 2022

Cancers

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According to the European and Japanese guidelines, additional treatment is recommended for cases of superficial esophageal squamous cell carcinoma (ESCC) and early gastric cancer (EGC) that do not meet the curability criteria for endoscopic resection (ER), i.e., non-curative ER, owing to the risk of lymph node metastasis (LNM). However, the rates of LNM in such cases were relatively low (e.g., 8% for EGC). Several recent advances have been made in this field. First, pathological risk stratification for metastatic recurrence following non-curative ER without additional treatment was developed for both superficial ESCC and EGC. Second, the pattern of metastatic recurrence and prognosis after recurrence following non-curative ER without additional treatment was found to be considerably different between superficial ESCC and EGC. Third, a combination of ER and selective chemoradiotherapy was developed as a minimally invasive treatment method for clinical T1b-SM ESCC. These findings may help clinicians decide the treatment strategy for patients following non-curative ER; however, for optimal therapeutic decision-making in such patients, it is also important to predict the prognosis other than SESCC or EGC and impaired quality of life. Thus, a novel algorithm that considers these factors, as well as metastatic recurrence, should be developed.

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Development of a prognostic model for early-stage gastric cancer-related DNA methylation-driven genes and analysis of immune landscape

Su,

Lin,

et al. 2024

Front. Mol. Biosci.

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Background and AimsThis study aimed to develop a prognostic model based on DNA methylation-driven genes for patients with early-stage gastric cancer and to examine immune infiltration and function across varying risk levels.MethodsWe analyzed data from stage I/II gastric cancer patients in The Cancer Genome Atlas which included clinical details, mRNA expression profiles, and level 3 DNA methylation array data. Using the empirical Bayes method of the limma package, we identified differentially expressed genes (DEGs), and the MethylMix package facilitated the identification of DNA methylation-driven genes (DMGs). Univariate Cox regression and LASSO (least absolute shrinkage and selector operation) analyses were utilized to pinpoint critical genes. A risk score prediction model was formulated using two genes that demonstrated the most significant hazard ratios (HRs). Model performance was evaluated within the initial cohort and verified in the GSE84437 cohort; a nomogram was also constructed based on these genes. We further examined 50 methylation sites associated with three CpG islands in C1orf35 and 14 methylation sites linked to one CpG island in FAAH. The CIBERSORT package was employed to identify immune cell clusters in the prediction model.ResultsA total of 176 DNA methylation-driven genes were refined down to a four-gene signature (ZC3H12A was hypermethylated; GATA3, C1orf35, and FAAH were hypomethylated), which exhibited a significant correlation with overall survival (OS), as evidenced by p-values below 0.05 following univariate Cox regression and LASSO analysis. Specifically, for the risk score prediction model, C1orf35, which had the highest hazard ratio (HR = 2.035, p = 0.028), and FAAH, with the lowest hazard ratio (HR = 0.656, p = 0.012), were selected. The Kaplan–Meier analysis demonstrated distinct survival outcomes between the high-risk and low-risk score groups. The model’s predictive accuracy was confirmed with an area under the curve (AUC) of 0.611 for 3-year survival and 0.564 for 5-year survival. Notably, the hypomethylation of the three CpG islands in C1orf35 and the single CpG island in FAAH was significantly different in stage I/II gastric cancer patients compared to normal tissues. Additionally, the high-risk score group showed a notable association with resting CD4 memory T cells.ConclusionPromoter hypomethylation of C1orf35 and FAAH in early-stage gastric cancer underscores their potential as biomarkers for accurate diagnosis and treatment. The developed predictive model employing genes affected by DNA methylation serves as a crucial independent prognostic factor in early-stage gastric cancer.

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Prognosis after curative resection for stage IA gastric cancer in elderly patients: endoscopic submucosal dissection versus surgery

Cited by 3 publications

References 52 publications

Comparison of endoscopic submucosal dissection versus surgery for early gastric cancer in the elderly: a pooled analysis

Comparison of endoscopic submucosal dissection versus surgery for early gastric cancer in the elderly: a pooled analysis

Management of Superficial Esophageal Squamous Cell Carcinoma and Early Gastric Cancer following Non-Curative Endoscopic Resection

Development of a prognostic model for early-stage gastric cancer-related DNA methylation-driven genes and analysis of immune landscape

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