Bone metastasis from early gastric cancer following non-curative endoscopic submucosal dissection

A 67-year-old male underwent endoscopic submucosal dissection(ESD)to treat early gastric cancer(EGC)in 2001.The lesion(50 mm × 25 mm diameter)was histologically diagnosed as poorly differentiated adenocarcinoma,with an ulcer finding.Although the tumor was confined to the mucosa with no evidence of lymphovascular involvement,the ESD was regarded as a noncurative resection due to the histological type,tumor size,and existence of an ulcer finding(as indicated by the 2010 Japanese gastric cancer treatment guidelines,ver.3).Despite strong recommendation for subsequent gastrectomy,the patient refused surgery.An alternative follow-up routine was designed,which included five years of biannual clinical examinations to detect and measure serum tumor markers and perform visual assessment of recurrence by endoscopy and computed tomography scan after which the examinations were performed annually.The patient's condition remained stable for eight years,until a complaint of back pain in 2010 prompted further clinical investigation.Bone scintigraphy indicated increased uptake.Histological examination of biopsy specimens taken from the lumbar spine revealed adenocarcinoma resembling the carcinoma cells from the EGC that had been treated previously by ESD,and which was consistent with immunohistochemical findings of gastrointestinal tract cancer.Thus,the diagnosis of bone metastasis from EGC was made.The reported rates of EGC recurrence in surgically resected cases range 1.4%-3.4%,but among these bone metastasis is very rare.To our knowledge,this is the first reported case of bone metastasis from EGC following a non-curative ESD and occurring after an eight-year disease-free interval.

Long-term outcomes of additional surgery versus non-gastrectomy treatment for early gastric cancer after non-curative endoscopic submucosal dissection: a meta-analysis

Background:Endoscopic resection is increasingly used in the treatment for early gastric cancer(EGC);however,about 15%of endoscopic submucosal dissection(ESD)cases report non-curative resection.The efficacy of different remedial interventions after non-curative ESD for EGC remains controversial.This meta-analysis aimed to compare the long-term outcomes of additional surgery and non-gastrectomy treatment for EGC patients who underwent non-curative ESD.Methods:All relevant studies published up to October 2021 were systematically searched in the PubMed,Web of Science,and Embase databases.The medical subject headings terms"early gastric cancer,""gastrectomy,""endoscopic submucosal dissection,"and their related free keywords were used to search relevant articles without restrictions on regions,publication types,or languages.The Newcastle–Ottawa Quality Assessment Scale was used to evaluate the quality of the included studies.Odds ratios(ORs)with 95%confidence intervals(CIs)of 5-year overall survival(OS),disease-specific survival(DSS),disease-free survival(DFS)and hazard ratios(HRs)with 95%CIs of OS were calculated using a random-or fixed-effects model.Results:This meta-analysis included 17 retrospective cohort studies with 5880 patients,of whom 3167 underwent additional surgery and 2713 underwent non-gastrectomy.We found that patients receiving additional gastrectomy had better 5-year OS(OR=3.63,95%CI=3.05–4.31),DSS(OR=3.22,95%CI=2.22–4.66),and DFS(OR=4.39,95%CI=1.78–10.82)outcomes than those receiving non-gastrectomy treatments.The pooled HR also showed that gastrectomy following non-curative ESD significantly improved OS(HR=0.40,95%CI=0.33–0.48).In addition,elderly patients benefited from additional surgery in consideration of the 5-year OS(HR=0.54,95%CI=0.41–0.72).Conclusions:Compared with non-gastrectomy treatments,additional surgery offered better long-term survival outcomes for patients with EGC who underwent non-curative ESD.

早期胃癌非根治性内镜切除术后追加胃切除术:meta分析

背景:对于行非根治性内镜切除术的早期胃癌患者,追加胃切除术的作用尚不明确。本研究旨在探讨早期胃癌患者非根治性内镜切除术的危险因素,并评价追加胃切除术的疗效。方法:在MedLine、Web of Science和EMBASE数据库中检索有关接受非根治性内镜切除术后追加胃切除术的文献报道。首先分析非根治性内镜切除术后肿瘤残留及淋巴结转移的危险因素,然后评估追加胃切除术患者的生存结果,包括5年总生存率、5年无病生存率和5年疾病特异生存率。结果:本研究纳入了21项研究共4870例病例。分析发现,肿瘤残留与肿瘤较大(>3 cm)(OR=2.81,P<0.001)、肿瘤为未分化类型(OR=1.78,P=0.011)以及切缘阳性(OR=9.78,P<0.001)有关。淋巴结转移与肿瘤较大(>3 cm)(OR=1.73,P<0.001)、肿瘤大体分型提高(OR=1.60,P=0.035)以及肿瘤浸润较深(OR=2.68,P<0.001)有关。追加胃切除术的患者较未追加者5年总生存率(HR=0.34,P<0.001)、5年无病生存率(HR=0.52,P=0.001)和5年疾病特异生存率(HR=0.50,P<0.001)均显著提高。而且老年患者也能从追加胃切除术中取得总生存获益(HR=0.41,P=0.001)。结论:追加胃切除术及淋巴结清扫可以延长早期胃癌患者非根治性内镜切除术后生存期。然后,应对这些患者进行危险分层以选择适宜的病例追加胃切除术,以避免过度治疗。