부산대학교 도서관

Objectives: The multi‐institutional, single‐arm, confirmatory trial JCOG0607 showed excellent efficacy of endoscopic submucosal dissection (ESD) for the expanded indication of intramucosal intestinal‐type early gastric cancer (EGC), which consists of two groups: lesions >2 cm if clinical finding of ulcer (cUL)‐negative, or those ≤3 cm if cUL‐positive because of the expected low risk of lymph node metastasis. However, the proportion of noncurative resections (NCR) requiring additional surgery was high (32.4%). This post hoc analysis aimed to explore the clinical factors associated with NCR. Methods: As the expanded indication includes two different groups, we explored the clinical factors associated with NCR separately in cUL‐negative (>2 cm) and cUL‐positive (≤3 cm) groups using the log–linear model. Results: Two hundred and sixty cUL‐negative and 206 cUL‐positive EGCs were analyzed. The proportions of NCR were 33.8% in the cUL‐negative group and 29.6% in the cUL‐positive group. A multivariable analysis demonstrated that moderately differentiated predominant histology diagnosed in pretreatment biopsy (risk ratio [RR] 1.93, 95% confidence interval [CI] 1.34–2.77, P < 0.001) and lesion in the upper stomach (RR 1.75, 95% CI 1.03–2.96, P = 0.038) in the cUL‐negative EGCs, and tumor size >2 cm (RR 1.78, 95% CI 1.22–2.58, P = 0.003) and female sex (RR 1.62, 95% CI 1.07–2.44, P = 0.021) in the cUL‐positive EGCs were independent factors associated with NCR. Conclusions: Clinical risk factors associated with NCR were different between cUL‐negative and cUL‐positive EGCs. To avoid NCR, we need to take these factors into account when deciding expanded indications for ESD. [ABSTRACT FROM AUTHOR]