Risk factors associated with non-curative resection and metachronous cancer after endoscopic submucosal dissection in patients with ulcerative early gastric cancer.

Abstract

Background: Endoscopic submucosal dissection (ESD) has become a primary treatment for early gastric cancer (EGC). Ulcerative EGC is more prone to non-curative resection (NCR) during ESD due to its unique pathological characteristics, and such cases are also associated with an increased risk of metachronous gastric cancer (MGC) after treatment. This study aims to evaluate the risk factors associated with NCR and the development of metachronous cancer in patients with ulcerative EGC after ESD.

Methods: We conducted a retrospective observational study on patients who underwent ESD for ulcerative EGC at the Affiliated Hospital of Qingdao University between 2015 and 2023. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with NCR after ESD, while univariate and multivariate Cox regression analyses were conducted to determine risk factors for the development of metachronous cancer following ESD.

Results: A total of 182 patients with ulcerative EGC were enrolled in the study, among whom 25 cases were pathologically confirmed as NCR. Multivariate logistic regression analysis revealed that lesion size measuring 20-30 mm and an undifferentiated histologic type on preoperative biopsy were independent risk factors for NCR (OR = 3.65, 95% CI 1.51-8.91, P = 0.004; OR = 5.40, 95% CI 1.36 - 21.35, P = 0.018, respectively). Age ≥ 65 years (HR = 3.953, 95% CI 0.993-15.735, P = 0.041) and indistinct ulcer margins (HR = 4.385, 95% CI 1.092-17.603, P = 0.037) were identified as independent risk factors for the development of M GC following ESD in patients with ulcerative EGC.

Conclusions: Lesion size of 20-30 mm and an undifferentiated histologic type on preoperative biopsy were identified as independent risk factors for NCR in patients with ulcerative EGC. In addition, older age and indistinct ulcer margins were significantly associated with an increased risk of MGC following ESD. Careful preoperative evaluation and long-term surveillance are essential for optimizing therapeutic outcomes in ulcerative EGC.