Endoscopy 2015; 47(12): 1113-1118
DOI: 10.1055/s-0034-1392484
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Long-term surveillance and treatment outcomes of metachronous gastric cancer occurring after curative endoscopic submucosal dissection

Seiichiro Abe
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Ichiro Oda
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Haruhisa Suzuki
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Satoru Nonaka
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Shigetaka Yoshinaga
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Takeshi Nakajima
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Masau Sekiguchi
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Genki Mori
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Hirokazu Taniguchi
2   Pathology Division, National Cancer Center Hospital, Tokyo, Japan
,
Shigeki Sekine
2   Pathology Division, National Cancer Center Hospital, Tokyo, Japan
,
Hitoshi Katai
3   Gastric Surgery Division, National Cancer Center Hospital, Tokyo, Japan
,
Yutaka Saito
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

submitted 28 November 2014

accepted after revision 14 May 2015

Publication Date:
10 July 2015 (online)

Background and study aims: As more early gastric cancer (EGC) patients are being treated with endoscopic submucosal dissection (ESD), it is important to understand the outcomes of patients who develop metachronous gastric cancer (MGC). The aim of this study was to evaluate the long-term surveillance and treatment outcomes of MGC after curative gastric ESD.

Patients and methods: The study included 1526 consecutive patients who underwent curative ESD resection of EGC. They were generally followed by annual or biannual esophagogastroduodenoscopy. The risk factors and treatment outcomes for MGC were assessed along with the 5-year, 7-year, and 10-year cumulative incidence functions of MGC and disease-specific survival (DSS).

Results: During a median follow-up period of 82.2 months, 238 patients developed MGC post-ESD resection of EGC. The 5-year, 7-year, and 10-year cumulative incidence functions of MGC were 9.5 %, 13.1 % and 22.7 %, respectively. Male sex and multiple initial EGCs were independent risk factors for MGC in the Cox proportional hazard model. Of the 238 patients with MGC, 215 were treated with endoscopic resection, of which 183 achieved curative resection, although one patient later died of his initial EGC. A further 14 patients were treated surgically, three had metastatic disease and received palliative chemotherapy, and the remaining six were observed without any intervention. A total of seven patients died of MGC, five at least 5 years after their index ESD. The 5-year, 7-year, and 10-year DSSs were 99.2 %, 98.6 %, and 92.5 %, respectively.

Conclusions: The incidence of MGC increases with time after curative gastric ESD, therefore surveillance endoscopy should be continued indefinitely.

 
  • References

  • 1 Oda I, Saito D, Tada M et al. A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 2006; 9: 262-270
  • 2 Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011; 14: 113-123
  • 3 Isomoto H, Shikuwa S, Yamaguchi N et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 2009; 58: 331-336
  • 4 Goto O, Fujishiro M, Kodashima S et al. Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. Endoscopy 2009; 41: 118-122
  • 5 Ahn JY, Jung HY, Choi KD et al. Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc 2011; 74: 485-493
  • 6 Gotoda T, Iwasaki M, Kusano C et al. Endoscopic resection of early gastric cancer treated by guideline and expanded National Cancer Centre criteria. Br J Surg 2010; 97: 868-871
  • 7 Toyonaga T, Man-i M, East JE et al. 1,635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes. Surg Endosc 2013; 27: 1000-1008
  • 8 Kosaka T, Endo M, Toya Y et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center retrospective study. Dig Endosc 2014; 26: 183-191
  • 9 Abe S, Oda I, Suzuki H et al. Short- and long-term outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Endoscopy 2013; 45: 703-707
  • 10 Nakajima T, Oda I, Gotoda T et al. Metachronous gastric cancers after endoscopic resection: how effective is annual endoscopic surveillance?. Gastric Cancer 2006; 9: 93-98
  • 11 Nasu J, Doi T, Endo H et al. Characteristics of metachronous multiple early gastric cancers after endoscopic mucosal resection. Endoscopy 2005; 37: 990-993
  • 12 Kato M, Nishida T, Yamamoto K et al. Scheduled endoscopic surveillance controls secondary cancer after curative endoscopic resection for early gastric cancer: a multicentre retrospective cohort study by Osaka University ESD study group. Gut 2013; 62: 1425-1432
  • 13 Kobayashi M, Narisawa R, Sato Y et al. Self-limiting risk of metachronous gastric cancers after endoscopic resection. Dig Endosc 2010; 22: 169-173
  • 14 Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011; 14: 101-112
  • 15 Gotoda T, Yanagisawa A, Sasako M et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 2000; 3: 219-225
  • 16 Sekiguchi M, Suzuki H, Oda I et al. Favorable long-term outcomes of endoscopic submucosal dissection for locally recurrent early gastric cancer after endoscopic resection. Endoscopy 2013; 45: 708-713
  • 17 Abe S, Oda I, Nakajima T et al. A case of local recurrence and distant metastasis following curative endoscopic submucosal dissection of early gastric cancer. Gastric Cancer 2015; 18: 188-192
  • 18 Onodera H, Tokunaga A, Yoshiyuki T et al. Surgical outcome of 483 patients with early gastric cancer: prognosis, postoperative morbidity and mortality, and gastric remnant cancer. Hepatogastroenterology 2004; 51: 82-85
  • 19 Hosokawa O, Kaizaki Y, Watanabe K et al. Endoscopic surveillance for gastric remnant cancer after early cancer surgery. Endoscopy 2002; 34: 469-473
  • 20 Ikeda Y, Saku M, Kishihara F et al. Effective follow-up for recurrence or a second primary cancer in patients with early gastric cancer. Br J Surg 2005; 92: 235-239
  • 21 Nozaki I, Hato S, Kobatake T et al. Incidence of metachronous gastric cancer in the remnant stomach after synchronous multiple cancer surgery. Gastric Cancer 2014; 17: 61-66
  • 22 Nashimoto A, Akazawa K, Isobe Y et al. Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry. Gastric Cancer 2013; 16: 1-27
  • 23 Nakagawa S, Asaka M, Kato M et al. Helicobacter pylori eradica and metachronous gastric cancer after endoscopic mucosal early gastric cancer. Aliment Pharmacol Ther 2006; 24: 214-218
  • 24 Fukase K, Kato M, Kikuchi S et al. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet 2008; 372: 392-397
  • 25 Bae SE, Jung HY, Kang J et al. Effect of Helicobacter pylori eradication on metachronous recurrence after endoscopic resection of gastric neoplasm. Am J Gastroenterol 2014; 109: 60-67
  • 26 Choi J, Kim SG, Yoon H et al. Eradication of Helicobacter pylori after endoscopic resection of gastric tumors does not reduce incidence of metachronous gastric carcinoma. Clin Gastroenterol Hepatol 2014; 12: 793-800
  • 27 Yanaoka K, Oka M, Ohata H et al. Eradication of Helicobacter pylori prevents cancer development in subjects with mild gastric atrophy identified by serum pepsinogen levels. Int J Cancer 2009; 125: 2697-2703
  • 28 Maehata Y, Nakamura S, Fujisawa K et al. Long-term effect of Helicobacter pylori eradication on the development of metachronous gastric cancer after endoscopic resection of early gastric cancer. Gastrointest Endosc 2012; 75: 39-46
  • 29 Oda I, Shimazu T, Ono H et al. Design of Japanese multicenter prospective cohort study of endoscopic resection for early gastric cancer using Web registry (J-WEB/EGC). Gastric Cancer 2012; 15: 451-454
  • 30 Asada K, Nakajima T, Shimazu T et al. Demonstration of the usefulness of epigenetic cancer risk prediction by a multicentre prospective cohort study. Gut 2015; 64: 388-396