Local or extragastric recurrence after incomplete endoscopic submucosal dissection of early gastric cancer: risk factors and the role of CT

Extragastric recurrence in patients who underwent surgical resection of stage I gastric cancer: Incidence, risk factors, and value of abdominal computed tomography as a postoperative surveillance method

Extragastric recurrence after radical resection of stage I gastric cancer is very rare. We investigated the incidence of extragastric recurrence and risk factors in patients who underwent surgical resection of stage I gastric cancer and evaluated the value of abdominal CT as a surveillance tool. This retrospective study enrolled 914 patients with stage I gastric cancer who underwent surgical resection at a single tertiary hospital. We investigated extragastric recurrence during the follow-up period, and disease-free survival (DFS) was assessed. Over a median follow-up period of 39 months, the overall incidence of extragastric recurrence was 2.2% (20/914). Risk factors for extragastric recurrence included deep submucosal invasion (SM2-3), muscularis propria invasion, and lymph node metastasis (hazard ratio [HR]=10.37, 28.101, and 6.843; P = .028, .002, and .001, respectively). Based on the number of risk factors, patients were stratified into 3 subgroups: low-risk (pT1aN0, pT1b(SM1)N0, 496/914), moderate-risk (pT1aN1, pT1b(SM1)N1, pT1b(SM2-3)N0, pT2N0, 369/914), and high-risk (pT1b(SM2-3)N1, 49/914). DFS was significantly longer in the low-risk group, followed by the moderate-risk and high-risk groups. We propose that postoperative CT surveillance should be omitted for stage 1A cases involving the mucosa and SM1 because of the extreme rarity of extragastric recurrence.

A model established using marital status and other factors from the Surveillance, Epidemiology, and End Results database for early stage gastric cancer

Currently, the postoperative prognosis of early stage gastric cancer (GC) is difficult to accurately predict. In particular, social factors are not frequently used in the prognostic assessment of early stage GC. Therefore, this study aimed to combine the clinical indicators and social factors to establish a predictive model for early stage GC based on a new scoring system. A total of 3647 patients with early stage GC from the Surveillance, Epidemiology, and End Results database were included in this study. A Kaplan-Meier survival analysis was used to compare differences in prognosis between different marital status, as an innovative prognostic indicator. Univariate and multivariate analyses were used to screen available prediction factors and then build a nomogram using the Cox proportional hazard regression model. The univariate analysis and multivariate analysis revealed that age at diagnosis, sex, histology, stage_T, surgery, tumor size, and marital status were independent prognostic factors of overall survival. Both the C-index and calibration curves confirmed that the nomogram had a great predictive effect on patient prognosis in training and testing sets. This nomogram based on clinical indicators and marital status can effectively help patients with early stage GC in the future.