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Prediction model for curative endoscopic submucosal dissection of undifferentiated-type early gastric cancer

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Abstract

Background

Endoscopic submucosal dissection (ESD) is an effective treatment for early gastric cancer (EGC); however, its curative resection rate is low for undifferentiated-type EGC. We developed and externally validated a prediction model for curative ESD of undifferentiated-type EGC.

Methods

In this cross-sectional study, we included 448 patients who underwent ESD for undifferentiated-type EGC at 18 hospitals in Korea between 2005 and 2015 in the development cohort and 1342 patients who underwent surgery at two hospitals in the validation cohort. A prediction model was developed using the logistic regression model.

Results

Endoscopic tumor size 1–2 cm (odds ratio [OR], 2.40; 95% confidence interval [CI] 1.54–3.73), tumor size > 2 cm (OR, 14.00; 95% CI 6.81–28.77), and proximal tumor location from the lower to upper third of the stomach (OR, 1.45; 95% CI 1.03–2.04) were independent predictors of non-curative ESD. A six-score prediction model was developed by assigning points to endoscopic tumor size > 2 cm (five points), tumor size 1–2 cm (two points), upper third location (two points), and middle third location (one point). The rate of curative ESD ranged from 70.6% (score 0) to 11.6% (score 5) with an area under the receiver operating characteristic curve (AUC) of 0.720 (95% CI 0.673–0.766). The model also showed good performance in the validation cohort (AUC, 0.775; 95% CI 0.748–0.803).

Conclusions

This six-score prediction model may help in predicting curative ESD and making informed decisions about the treatment selection between ESD and surgery for undifferentiated-type EGC.

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Funding

This work was supported by the Korean College of Helicobacter and Upper Gastrointestinal Research (Woon Geon Shin in 2017 and Hyo-Joon Yang in 2018) and the National Research Foundation of Korea (2020R1G1A1010927).

Author information

Author notes

  1. Moon Kyung Joo and Jae Myung Park have contributed equally to this paper.

Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Hyo-Joon Yang

  2. Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea

    Moon Kyung Joo

  3. Department of Internal Medicine, Seoul St. Mary′s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Jae Myung Park

  4. Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea

    Ji Yong Ahn

  5. Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea

    Jae-Young Jang

  6. Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea

    Joo Hyun Lim

  7. Gastroenterology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea

    Su Youn Nam

  8. Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Jie-Hyun Kim

  9. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Byung-Hoon Min

  10. Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea

    Wan-Sik Lee

  11. Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea

    Bong Eun Lee

  12. Department of Internal Medicine, Hallym University College of Medicine, Seoul, Republic of Korea

    Woon Geon Shin

  13. Division of Gastroenterology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea

    Hang Lak Lee

  14. Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary′s Hospital, The Catholic University of Korea, College of Medicine, Incheon, Republic of Korea

    Tae-Geun Gweon

  15. Department of Internal Medicine, Kosin University College of Medicine, Busan, Republic of Korea

    Moo In Park

  16. Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea

    Jeongmin Choi

  17. Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea

    Chung Hyun Tae

  18. Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea

    Young-Il Kim, Keun Won Ryu & Il Ju Choi

Authors
  1. Hyo-Joon Yang
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  2. Moon Kyung Joo
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  14. Tae-Geun Gweon
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  15. Moo In Park
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  16. Jeongmin Choi
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  18. Young-Il Kim
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  19. Keun Won Ryu
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  20. Il Ju Choi
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Corresponding authors

Correspondence to Moon Kyung Joo or Jae Myung Park.

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Disclosures

Hyo-Joon Yang, Moon Kyung Joo, Jae Myung Park, Ji Yong Ahn, Jae-Young Jang, Joo Hyun Lim, Su Youn Nam, Jie-Hyun Kim, Byung-Hoon Min, Wan-Sik Lee, Bong Eun Lee, Woon Geon Shin, Hang Lak Lee, Tae-Geun Gweon, Moo In Park, Jeongmin Choi, Chung Hyun Tae, Young-Il Kim, Keun Won Ryu and Il Ju Choi have no conflicts of interest or financial ties to disclose.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

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Yang, HJ., Joo, M.K., Park, J.M. et al. Prediction model for curative endoscopic submucosal dissection of undifferentiated-type early gastric cancer. Surg Endosc 36, 1414–1423 (2022). https://doi.org/10.1007/s00464-021-08426-w

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