Characteristics of Metachronous Gastric Tumors after Endoscopic Submucosal Dissection for Gastric Intraepithelial Neoplasms

Background.Recently, endoscopic submucosal dissection (ESD) has become a standard treatment method for early gastric cancer and concurrent stomach preservation. However, metachronous recurrences have become a major problem. We evaluated the incidence and clinicopathologic features of and examined the risk factors for metachronous gastric tumors.Methods.A total of 357 patients who underwent ESD for gastric tumors (245 early gastric cancers and 112 adenomas) and were followed up for more than 12 months without recurrence within the first 12 months were enrolled. We investigated the incidence and clinicopathologic features of metachronous tumors after ESD. We also analyzed the potential risk factors for metachronous tumors using the Kaplan-Meier method and Cox’s proportional hazards model.Results.The annual incidence of metachronous tumors after ESD was 2.4%. The median period until discovery after initial ESD was 26.0 months, and the median observation period was 52.6 months. Male patients developed metachronous tumors more frequently (P=0.04), and the hazard ratio of female to male patients was 0.36 (95% confidence interval: 0.11–0.89).Conclusions.Patients with a previous history of gastric tumors have a high risk of subsequent gastric tumor development and male patients should be carefully followed up after ESD for gastric tumor.

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The incidence and clinicopathologic features of metachronous gastric tumors after endoscopic submucosal dissection.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.37 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 37-37

Author(s):

Sung Won Park ◽

Yun Ho Lee ◽

Dae Young Kim ◽

Song I Bae ◽

Won Jae Yoon ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Large Scale ◽

Clinicopathologic Features ◽

Gastric Tumors ◽

Female Patients ◽

Submucosal Dissection ◽

Median Period ◽

Male Patients ◽

H Pylori ◽

Metachronous Tumors

37 Background: Endoscopic submucosal dissection (ESD) has become a standard method of treatment for gastric tumors. The synchronous and metachronous development of two or more primary adenocarcinomas occurs in 10 to 20% of all cases of stomach cancer. Therefore, metachronous recurrence should be a consideration after ESD has been performed. The aim of this study was to review our experiences in the management of patients with synchronous and metachronous lesions, and to evaluate their incidence and clinicopathologic features. Methods: We reviewed 194 patients who underwent ESD for gastric tumors between January 2007 and December 2011. Synchronous lesions were defined as secondary gastric tumors detected within 6 months after the initial ESD. Metachronous tumors were defined as those detected more than 6 months after the initial ESD. We investigated the incidence and clinicopathologic features of synchronous and metachronous tumors after ESD. Results: In total, 20 patients (10.3%) had synchronous lesions and 19 patients (9.8%) had metachronous lesions. The annual incidence of metachronous tumors after ESD was 2.93%. The median period until discovery after initial ESD was 40.1 months. Female patients developed synchronous and metachronous tumors more frequently than male patients (p = 0.037). Patients with H. pyloriinfections developed tumors more frequently than those without (p = 0.04). There were no significant differences with respect to the type and differentiation of tumors. Conclusions: Synchronous and metachronous lesions of gastric tumors were considerably prevalent after ESD. Considering the results of this study, careful endoscopic investigation should be performed after ESD for female patients and those with H. pylori infections. However, further large-scale and longer prospective studies are needed.

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