Introduction
Methods
Patient enrolment, diagnosis, and staging workup
Treatment strategy
Response assessment
Statistical analysis
Results
Patient baseline characteristics
Characteristics | Values |
---|---|
Age, median (range) | 56.0 (21.0–87.0) years |
Sex | |
Male | 83 (40.9%) |
Female | 120 (59.1%) |
Lactate dehydrogenase | 364.0 (198.0–1640.0) IU/L |
Elevated | 27 (13.3%) |
Normal | 176 (86.7%) |
ECOG performance status | |
0–1 | 198 (97.5%) |
2 | 5 (2.5%) |
Clinical presentation | |
No symptoms | 112 (55.2%) |
Epigastric pain | 51 (25.1%) |
Bloating | 26 (12.8%) |
Weight loss | 11 (5.4%) |
Nausea and vomiting | 10 (4.9%) |
GI bleeding | 6 (3.0%) |
B-symptoms | 16 (7.9%) |
Initial HPI positive† | 151 (74.4%) |
Diagnosis method | |
Histology | |
Warthin-Starry stain | 38 (30.6%) |
Giemsa stain | 58 (46.8%) |
PCR | 28 (22.6%) |
Rapid urease test (CLO test) | 44 (29.1%) |
13C Urea breath test with H. pylori IgG positive | 10 (6.6%) |
Initial HPI negative* | 52 (25.6%) |
Diagnostic location in gastroduodenoscopy | |
Antrum | 63 (31.0%) |
Body | 66 (32.5%) |
High/middle/low body | 20 (30.3%)/10 (15.2%)/36 (54.5%) |
Antrum + low body | 27 (13.3%) |
Fundus | 28 (13.8%) |
Diffuse | 19 (9.4%) |
Anatomic location | |
Proximal upper-third/multiple | 67 (33.0%) |
Distal two-thirds | 136 (67.0%) |
Endoscopic type | |
Superficial | 103 (50.7%) |
Others § | 100 (49.3%) |
Invasion depth measured by EUS (n = 89)‡ | |
Mucosa | 49 (55.1%) |
Submucosa | 25 (28.1%) |
Muscularis propria to serosa | 15 (16.8%) |
MALT-IPI | |
Low (0) | 142 (70.0%) |
Intermediate (1) | 12 (5.9%) |
High (2–3) | 49 (24.1%) |
Lugano stage and Paris TNMB stage** | |
Localized stage | |
Stage I (T1–4N0M0–1, B0) | 176 (86.7%) |
Stage II1 (T1–4N1M0–1, B0) | 5 (2.5%) |
Advanced stage | |
Stage II2 (T1-4N2M0-1, B0) | 1 (0.5%) |
Stage IIE (T1–4N1M0–1, B0) | 4 (2.0%) |
Stage IV (T1–4N3M0–1B0, T1–4N0– 2M2B0 or B1) | 17 (8.4%) |
Bone marrow involvement | 7 (3.4%) |
H. pylori eradication and treatment responses in HPI-positive group patients
Variables | Values |
---|---|
HPI-positive, Stage I or II1 (n = 144)* | |
First-line eradication | 101 (49.8%) |
Second-line eradication | 43 (21.2%) |
HPI eradication response rate | 112/144 (77.8%) |
Eradication failure | 15 (10.4%) |
Treatment response† | |
Stable disease (NC)‡ | 15 (10.4%) |
Partial remission (rRD) up to 12 months | 17 (11.8%) |
Complete remission (ChR and pMRD)§ | 112 (77.8%) |
HPI-negative, Any stage (n = 59) | |
Chemotherapy | 27 (45.7%) |
Radiotherapy | 25 (42.4%) |
Chemotherapy + consolidative radiotherapy | 2 (3.4%) |
Observation after EMR | 5 (8.5%) |
Treatment response | |
Progressive disease | 5 (8.5%) |
Complete remission | 54 (91.5%) |
Variables | Non-responder* (n = 32) | Responder (n = 112) | p-value | All patients (n = 144) | Selected patients (n = 66)† | ||
---|---|---|---|---|---|---|---|
OR (95% CI) | p-value | OR (95% CI) | p-value | ||||
Age ≥ 60 | 8 (25.0%) | 37 (33.0%) | 0.387 | 1.567 (0.608–4.041) | 0.353 | 1.032 (0.232–4.597) | 0.967 |
Male | 16 (50.0%) | 41 (36.6%) | 0.172 | 1.908 (0.836–4.352) | 0.125 | 1.664 (0.541–5.116) | 0.374 |
Proximal upper-third/multiple | 15 (46.9%) | 24 (21.4%) | 0.004 | 3.235 (1.413–7.406) | 0.005 | 2.628 (0.823–8.395) | 0.103 |
Superficial type | 15 (46.9%) | 63 (56.2%) | 0.348 | 0.835 (0.362–1.928) | 0.673 | 0.871 (0.281–2.700) | 0.811 |
Lugano stage I | 31 (96.9%) | 110 (98.2%) | 0.532 | 0.950 (0.066–13.62) | 0.950 | - | - |
MALT IPI low risk | 26 (81.3%) | 89 (79.5%) | 0.824 | 0.842 (0.268–2.643) | 0.768 | 0.968 (0.235–3.982) | 0.964 |
EUS (≥ SM) (n = 66) | 12 (60.0%) | 15 (32.6%) | 0.038 | 3.100 (1.046–9.187) | 0.041 |
Treatment and responses of HPI-negative group patients
Category | First-line radiotherapy (n = 25) | First-line chemotherapy (n = 2 7) | p-value |
---|---|---|---|
Treatment modalities | 3060 cGy dose, 17 fraction Whole-stomach irradiation | Eight cycles of R-CVP | - |
- | |||
Clinical characteristics | |||
Age | 0.554 | ||
≥ 60 years (n = 29) | 15 (60.0%) | 14 (51.9%) | |
< 60 years (n = 23) | 10 (40.0%) | 13 (48.1%) | |
Sex | 0.250 | ||
Male (n = 23) | 9 (36.0%) | 14 (51.9%) | |
Female (n = 29) | 16 (64.0%) | 13 (48.1%) | |
Dominant site of lesion | 0.797 | ||
Proximal upper-third/multiple (n = 39) | 13 (52.0%) | 15 (55.6%) | |
Distal two-thirds (n = 105) | 12 (48.0%) | 12 (44.4%) | |
Endoscopic type | 0.174 | ||
Superficial (n = 78) | 13 (52.0%) | 19 (70.4%) | |
Others (n = 66) | 12 (48.0%) | 8 (29.6%) | |
Lugano stage | < 0.001 | ||
Stage I (n = 29) | 24 (96.0%) | 5 (18.5%) ‡ | |
Stage II1–2 (n = 2) | 1 (4.0%) | 1 (3.7%) | |
Stage IIE (n = 4) | 0 | 4 (14.8%) | |
Stage IV (n = 17) | 0 | 17 (63.0%) | |
MALT-IPI | < 0.001 | ||
Low (n = 21) | 17 (68.0%) | 4 (14.8%) | |
Intermediate to high (n = 31) | 8 (32.0%) | 23 (85.2%) | |
ECOG performance status | < 0.001 | ||
0–1 (n = 47) | 25 (100%) | 22 (81.5%) | |
2 (n = 5) | 0 | 5 (18.5%) | |
Treatment outcomes | |||
CR | 25 (100%) | 22 (81.5%) | 0.052 |
PD | 0 | 5 (18.5%) | 0.165 |
Adverse events | |||
AE grade (NCI-CTC-AE ver. 5.0) | Gastric discomfort (n = 4, 16.0%) Grade III–IV (n = 0) | Neutropenia (n = 19, 70.4%) Grade III–IV (n = 11, 40.7%) | - |
Nausea (n = 3, 12.0%) Grade III–IV (n = 1, 4.0%) | Anemia (n = 12, 44.5%) Grade III–IV (n = 4, 14.8%) | - | |
- | Thrombocytopenia (n = 6, 22.2%) Grade III–IV (n = 2, 7.4%) | - | |
- | Peripheral neuropathy (n = 7, 25.9%) Grade III–IV (n = 0) | - | |
- | Infection (n = 3, 11.1%) Grade III–IV (n = 1, 3.7%) | - |
Clinical outcomes and prognostic factor analysis
Variables | HR (95% CI) | p-values |
---|---|---|
PFS | ||
Male | 2.274 (0.939–5.505) | 0.069 |
Non-superficial endoscopic type | 2.071 (0.796–5.389) | 0.136 |
HPI negative | 3.281 (1.393–7.725) | 0.006 |
CIR | ||
Proximal upper-third/multiple location | 3.442 (1.246–9.509) | 0.007 |
HPI negative | 2.305 (0.837–6.351) | 0.110 |