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01-10-2017 | Gastrointestinal Oncology

Survival Benefit of Additional Surgery After Non-curative Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score Matching Analysis

Authors: Sho Suzuki, MD, PhD, Takuji Gotoda, MD, PhD, Waku Hatta, MD, PhD, Tsuneo Oyama, MD, PhD, Noboru Kawata, MD, Akiko Takahashi, MD, Yoshikazu Yoshifuku, MD, Shu Hoteya, MD, PhD, Masahiro Nakagawa, MD, PhD, Masaaki Hirano, MD, PhD, Mitsuru Esaki, MD, Mitsuru Matsuda, MD, PhD, Ken Ohnita, MD, PhD, Kohei Yamanouchi, MD, PhD, Motoyuki Yoshida, MD, Osamu Dohi, MD, PhD, Jun Takada, MD, PhD, Keiko Tanaka, MD, Shinya Yamada, MD, PhD, Tsuyotoshi Tsuji, MD, PhD, Hirotaka Ito, MD, PhD, Yoshiaki Hayashi, MD, PhD, Tooru Shimosegawa, MD, PhD

Published in: Annals of Surgical Oncology | Issue 11/2017

Abstract

Background and Purpose

Previous studies comparing survival outcomes between patients who did and did not undergo additional surgery after non-curative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) were limited in that the baseline characteristics differed significantly between the groups. We aimed to address this limitation and compared survival outcomes between these two groups using propensity score matching analysis.

Methods

The study enrolled 1969 consecutive patients who underwent non-curative ESD for EGC between 2000 and 2011 at any of 19 institutions across Japan. Using propensity score matching analysis, patients who underwent additional surgery (n = 1064) were compared with patients who did not (n = 905). Overall survival (OS) and disease-specific survival (DSS) after ESD were compared between both groups.

Results

Propensity score matching analysis yielded 553 matched pairs and well-balanced baseline characteristics between the two groups. The 5-year OS rates were 91.0% in the additional surgery group and 75.5% in the no additional surgery group, and the 5-year DSS rates were 99.0 and 96.8%, respectively. OS and DSS in the additional surgery group were significantly higher than in the no additional surgery group (OS, p < 0.001; DSS, p = 0.013). In Cox proportional hazard analysis, additional surgery significantly reduced gastric cancer-related death after non-curative ESD for EGC (hazard ratio 0.33, 95% confidence interval 0.12–0.79, p = 0.012).

Conclusions

Our findings suggest that additional surgery reduces mortality after non-curative ESD for EGC. We recommend additional surgery for patients after non-curative ESD for EGC.

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Title: Survival Benefit of Additional Surgery After Non-curative Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score Matching Analysis
Authors: Sho Suzuki, MD, PhD
Takuji Gotoda, MD, PhD
Waku Hatta, MD, PhD
Tsuneo Oyama, MD, PhD
Noboru Kawata, MD
Akiko Takahashi, MD
Yoshikazu Yoshifuku, MD
Shu Hoteya, MD, PhD
Masahiro Nakagawa, MD, PhD
Masaaki Hirano, MD, PhD
Mitsuru Esaki, MD
Mitsuru Matsuda, MD, PhD
Ken Ohnita, MD, PhD
Kohei Yamanouchi, MD, PhD
Motoyuki Yoshida, MD
Osamu Dohi, MD, PhD
Jun Takada, MD, PhD
Keiko Tanaka, MD
Shinya Yamada, MD, PhD
Tsuyotoshi Tsuji, MD, PhD
Hirotaka Ito, MD, PhD
Yoshiaki Hayashi, MD, PhD
Tooru Shimosegawa, MD, PhD
Publication date: 01-10-2017
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 11/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-017-6039-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Survival Benefit of Additional Surgery After Non-curative Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score Matching Analysis

Abstract

Background and Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and Purpose

Methods

Results

Conclusions

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