内镜下未分化早期胃癌切除术。

IF 3.2 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Journal of Gastric Cancer Pub Date : 2023-01-01 DOI:10.5230/jgc.2023.23.e13
Yuichiro Hirai, Seiichiro Abe, Mai Ego Makiguchi, Masau Sekiguchi, Satoru Nonaka, Haruhisa Suzuki, Shigetaka Yoshinaga, Yutaka Saito
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引用次数: 3

摘要

在东亚国家,内镜切除(ER)被广泛用于早期胃癌(EGC),其淋巴结转移(LNM)的风险可以忽略不计。特别是内镜下粘膜下剥离术(ESD),整体切除率高,病理评估准确。由于未分化EGC (UD-EGC)比分化EGC (D-EGC)导致更高的LNM发生率和浸润性生长,因此与D-EGC相比,ER的适应症有限。此前,在美国、欧洲、韩国和日本的指南中,临床分期为粘膜内UD-EGC≤2 cm,无溃疡,被列为ER的“弱推荐”或“扩大适应症”。基于日本临床肿瘤小组(JCOG) 1009/1010的前瞻性多中心研究的长期结果,该适应症的地位已经扩大,现在在2021年发布的最新日本指南中被认为是“绝对适应症”。本研究纳入了275例接受ESD治疗的UD-EGC (cT1a,≤2 cm,无溃疡)患者,5年总生存率(OS)为99.3%(95%置信区间,97.1%-99.8%),高于5年OS阈值(89.9%)。目前,日本、韩国和西方国家对UD-EGC ER的证据等级和建议水平存在差异。因此,除日本外,有必要进一步讨论UD-EGC的ER适应症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Endoscopic Resection of Undifferentiated Early Gastric Cancer.

Endoscopic resection (ER) is widely performed for early gastric cancer (EGC) with a negligible risk of lymph node metastasis (LNM) in Eastern Asian countries. In particular, endoscopic submucosal dissection (ESD) leads to a high en bloc resection rate, enabling accurate pathological evaluation. As undifferentiated EGC (UD-EGC) is known to result in a higher incidence of LNM and infiltrative growth than differentiated EGC (D-EGC), the indications for ER are limited compared with those for D-EGC. Previously, clinical staging as intramucosal UD-EGC ≤2 cm, without ulceration, was presented as 'weakly recommended' or 'expanded indications' for ER in the guidelines of the United States, Europe, Korea, and Japan. Based on promising long-term outcomes from a prospective multicenter study by the Japan Clinical Oncology Group (JCOG) 1009/1010, the status of this indication has expanded and is now considered 'absolute indications' in the latest Japanese guidelines published in 2021. In this study, which comprised 275 patients with UD-EGC (cT1a, ≤2 cm, without ulceration) treated with ESD, the 5-year overall survival (OS) was 99.3% (95% confidence interval, 97.1%-99.8%), which was higher than the threshold 5-year OS (89.9%). Currently, the levels of evidence grades and recommendations for ER of UD-EGC differ among Japan, Korea, and Western countries. Therefore, a further discussion is warranted to generalize the indications for ER of UD-EGC in countries besides Japan.

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来源期刊
Journal of Gastric Cancer
Journal of Gastric Cancer Biochemistry, Genetics and Molecular Biology-Cancer Research
CiteScore
4.30
自引率
12.00%
发文量
36
期刊介绍: The Journal of Gastric Cancer (J Gastric Cancer) is an international peer-reviewed journal. Each issue carries high quality clinical and translational researches on gastric neoplasms. Editorial Board of J Gastric Cancer publishes original articles on pathophysiology, molecular oncology, diagnosis, treatment, and prevention of gastric cancer as well as articles on dietary control and improving the quality of life for gastric cancer patients. J Gastric Cancer includes case reports, review articles, how I do it articles, editorials, and letters to the editor.
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