BACKGROUND AND STUDY AIMS:Following noncurative endoscopic resection of early gastric cancer (EGC), the patient should be observed when the underlying disease is severe, the patient is elderly, or the patient refuses further treatment. The aim of this study was to analyze the clinical outcomes of patients with differentiated EGC who underwent noncurative endoscopic resection without additional treatment. PATIENTS AND METHODS:Included patients underwent noncurative endoscopic resection for differentiated EGC without additional treatment at the Asan Medical Center between July 1994 and January 2009. Clinical and oncological outcomes were analyzed. RESULTS:A total of 159 patients were included in the analysis. The median follow-up period was 33 months (interquartile range [IQR] 22 - 52 months). In total, 40 patients died (25.2 %) - 3 due to stomach cancer, 34 due to other causes, and 3 from unknown causes; the median survival time after endoscopic treatment for these patients was 27.5 months (IQR 13.8 - 48.3 months). Multivariate analysis showed that the rates of underlying disease (P < 0.001) and lymphovascular invasion (P = 0.005) were higher among the 40 patients who died than among the 119 survivors. The overall 3-  and 5-year survival rates were 82.9 % and 77.1 %, respectively; the rates of the patients with lymphovascular invasion were 61.9 % and 42.4 %, respectively, and the rates of patients without lymphovascular invasion were 86.1 % and 81.8 %, respectively (P < 0.001). CONCLUSIONS:Additional treatment provides fewer benefits to patients who do not have long life expectancies. Additional surgery can be considered for patients with lymphovascular invasion because of its high mortality rate; however, the benefits and risks of surgery should be considered carefully.

译文

背景与研究目的:在早期胃癌(EGC)的非根治性内镜切除术之后,当潜在疾病严重,患者年老或患者拒绝进一步治疗时,应观察患者。这项研究的目的是分析未经治疗的内镜下切除术而无需额外治疗的分化型EGC患者的临床结局。
患者与方法:1994年7月至2009年1月间,在Asan医疗中心对包括EGC在内镜下进行非根治性内镜切除术的患者进行了分化EGC治疗,无额外治疗。分析了临床和肿瘤学结局。
结果:总共159例患者被纳入分析。中位随访期为33个月(四分位间距[IQR] 22±52个月)。共有40例患者(25.2 %%)died- 3因胃癌死亡,34因其他原因死亡,3因不明原因死亡;这些患者经内镜治疗后的中位生存时间为27.5个月(IQR 13.8±48.3个月)。多因素分析显示,死亡的40例患者的基础疾病(P(<0.001)和淋巴管浸润(P = 0.005)的发生率高于119名幸存者。 3年和5年总生存率分别为82.9%和77.1%。淋巴管浸润患者的发生率分别为61.9%和42.4%,无淋巴管浸润的患者分别为86.1%和81.8%(P <0.001)。
结论:额外治疗对没有预期寿命的患者提供的益处较少。由于其高死亡率,可以考虑对淋巴管侵犯的患者进行额外的手术。但是,应仔细考虑手术的益处和风险。

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