Introduction
Materials and methods
Patient selection
Pathological investigation methods
Specimen collection
Endoscopic submucosal dissection (ESD)
Surgical treatment
Pathological examination
Histopathological evaluation
Lymphatic invasion assessment
Inclusion in histopathological evaluation
Depth of submucosal (SM) invasion
Imaging modalities
Pre-operation preparation and operation procedure
Variables
Definition
Data analysis
Results
Inclusion of exclusion process
Baseline information of patients in the training and validation groups
ESD(n = 262) | Surgery(n = 277) | P-value | ||
---|---|---|---|---|
Gender(%) | 0.060 | |||
Male | 204(77.9) | 234(84.5) | ||
Female | 58(22.1) | 43(15.5) | ||
Age(%) | 0.664 | |||
< 60 y | 151(57.6) | 154(55.6) | ||
≥ 60 y | 111(42.4) | 123(44.4) | ||
ASA(%) | 0.420 | |||
I | 235(89.7) | 242(87.4) | ||
II | 27(10.3) | 35(12.6) | ||
ECOG PS(%) | ||||
0 | 210(80.2) | 221(79.8) | ||
1 | 52(19.8) | 56(20.2) | ||
Family history of gastric cancer(%) | 0.151 | |||
Yes | 34(13.0) | 26(9.4) | ||
No | 228(87.0) | 251(90.6) | ||
Tumor location(%) | 0.812 | |||
Cardia | 53(20.2) | 58(21.0) | ||
Fundus | 62(23.7) | 67(24.2) | ||
Body | 97(37.0) | 102(36.8) | ||
Antrum | 50(19.1) | 50(18.0) | ||
Tumor size(%) | 0.299 | |||
< 2 cm | 110(42.0) | 129(46.6) | ||
≥ 2 cm | 152(58.0) | 148(53.4) | ||
Differentiation(%) | 0.678 | |||
High | 77(29.4) | 86(31.1) | ||
Moderate | 139(53.0) | 142(51.3) | ||
Poor | 46(17.6) | 49(17.7) | ||
Vascular invasion(%) | 0.715 | |||
No | 178(67.9) | 184(66.4) | ||
Yes | 84(32.1) | 93(33.6) | ||
P53(%) | < 0.001 | |||
No | 155(59.2) | 121(43.7) | ||
Yes | 107(40.8) | 156(56.3) | ||
Ki-67(%) | 0.814 | |||
< 50% | 162(61.8) | 186(67.2) | ||
≥ 50% | 100(38.2) | 91(32.8) | ||
Tumor infiltration(%) | 0.874 | |||
Mucosa | 97(37.0) | 96(34.7) | ||
Submucosa SM1 | 165(63.0) | 181(65.3) | ||
MSI status(%) | 0.139 | |||
MSS/MSI-low | 237(90.5) | 257(92.8) | ||
MSI-high | 25(9.5) | 20(7.2) | ||
Cardiovascular disease | 0.532 | |||
No | 170(64.9) | 172(62.1) | ||
Yes | 92(35.1) | 105(37.9) | ||
Liver disease | 0.369 | |||
No | 249(95.0) | 258(93.1) | ||
Yes | 13(5.0) | 19(6.9) | ||
Renal disease | 0.146 | |||
No | 254(96.9) | 261(94.2) | ||
Yes | 8(3.1) | 16(5.8) | ||
Respiratory disease | 0.568 | |||
No | 255(97.3) | 272(98.2) | ||
Yes | 7(2.7) | 5(1.8) | ||
Diabetes | 0.465 | |||
No | 227(86.6) | 233(84.1) | ||
Yes | 35(13.4) | 44(15.9) |
Univariate and multivariate Cox regression analysis of predictors for gastric cancer patient survival time
Univariate analysis | Multivariate analysis | |||||
---|---|---|---|---|---|---|
P | HR | 95% confidence interval | P | HR | 95% confidence interval | |
Gender male/female | 0.219 | 0.847 | 0.648–1.107 | |||
Age > 60 y/≤60 y | 0.091 | 1.027 | 0.996–1.059 | |||
ASA II/I | 0.316 | 1.172 | 0.861–1.593 | |||
ECOG PS 1/0 | 0.123 | 1.234 | 0.945–1.614 | |||
Family history of gastric cancer Yes/No | 0.066 | 1.386 | 0.979–1.963 | |||
Tumor size > 2.0 cm/≤2.0 cm | 0.024 | 1.569 | 1.062–2.318 | 0.084 | 1.482 | 0.977–2.184 |
Differentiation Poorly/ high + Moderately | 0.037 | 1.449 | 1.023–2.054 | 0.021 | 1.514 | 1.142–2.134 |
Vascular invasion Yes/No | < 0.001 | 1.962 | 1.441–2.728 | < 0.001 | 1.778 | 1.389–2.633 |
P53 Yes/No | 0.007 | 1.563 | 1.131–2.157 | 0.062 | 1.801 | 0.907–2.243 |
Ki-67 ≥ 50%/<50% | 0.283 | 1.186 | 0.863–1.630 | |||
Tumor infiltration Submucosa/ Mucosa | 0.024 | 1.274 | 1.033–1.571 | 0.077 | 1.189 | 0.968–1.355 |
MSI status MSI-high/ (MSS/MSI-low) | 0.353 | 0.856 | 0.613–1.195 | |||
Treatment method ESD/ gastrectomy | 0.133 | 1.121 | 0.981–1.235 |
Univariate and multivariate Cox regression analysis of predictors for gastric cancer patient recurrence time
Univariate analysis | Multivariate analysis | |||||
---|---|---|---|---|---|---|
P | HR | 95% confidence interval | P | HR | 95% confidence interval | |
Gender male/female | 0.176 | 1.129 | 0.940–1.357 | |||
Age > 60 y/≤60 y | 0.062 | 1.201 | 0.989–1.458 | |||
ASA II/I | 0.482 | 1.069 | 0.848–1.345 | |||
ECOG PS 1/0 | 0.347 | 0.892 | 0.692–1.147 | |||
Family history of gastric cancer Yes/No | 0.079 | 1.256 | 0.971–1.623 | |||
Tumor size > 2.0 cm/≤2.0 cm | 0.019 | 1.395 | 1.063–1.832 | 0.091 | 1.241 | 0.927–1.663 |
Differentiation Poorly/ high + Moderately | 0.029 | 1.342 | 1.032–1.746 | 0.037 | 1.286 | 1.017–1.624 |
Vascular invasion Yes/No | < 0.001 | 2.014 | 1.548–2.616 | < 0.001 | 1.852 | 1.381–2.454 |
P53 Yes/No | 0.006 | 1.546 | 1.133–2.114 | 0.023 | 1.389 | 1.047–1.844 |
Ki-67 ≥ 50%/<50% | 0.301 | 1.153 | 0.896–1.484 | |||
Tumor infiltration Submucosa/ Mucosa | 0.018 | 1.405 | 1.065–1.856 | 0.052 | 1.224 | 0.999–1.501 |
MSI status MSI-high/ (MSS/MSI-low) | 0.485 | 1.114 | 0.844–1.472 | |||
Treatment method ESD/ gastrectomy | 0.102 | 1.200 | 0.973–1.479 |
The OS and RFS of the ESD versus surgery in EGC patients
Comparison of postoperative complications between patients in the ESD and Surgical groups
Postoperative complications | ESD group (n = 262) | Surgery group (n = 277) | P-Value |
---|---|---|---|
Gastric perforation | 2 (0.8) | 17(20.9) | 0.156 |
Bleeding | 1 (0.4) | 5 (1.8) | 0.352 |
Infection | 1 (0.4) | 3 (1.1) | 0.467 |
Delayed gastric emptying | 0(0.0) | 2 (0.7) | 0.496 |
Pulmonary infection | 0(0.0) | 2 (0.7) | 0.499 |
Diarrhea | 0(0.0) | 0(0.0) | 1.000 |
Arterial thrombosis | 0(0.0) | 1(0.4) | 0.496 |
Venous thrombosis | 0(0.0) | 0(0.0) | 1.000 |
Respiratory distress | 0(0.0) | 1(0.4%) | 0.496 |
Arrhythmia | 0(0.0) | 0(0.0) | 1.000 |
Total | 4 (1.5%) | 21 (7.6%) | 0.012 |