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Prediction model for non-curative resection of endoscopic submucosal dissection in patients with early gastric cancer

Authors
 Eun Hye Kim  ;  Jun Chul Park  ;  In Ji Song  ;  Yeong Jin Kim  ;  Dong Hoo Joh  ;  Kyu Yeon Hahn  ;  Yong Kang Lee  ;  Ha Yan Kim  ;  Hyunsoo Chung  ;  Sung Kwan Shin  ;  Sang Kil Lee  ;  Yong Chan Lee 
Citation
 GASTROINTESTINAL ENDOSCOPY, Vol.85(5) : 976-983, 2017 
Journal Title
GASTROINTESTINAL ENDOSCOPY
ISSN
 0016-5107 
Issue Date
2017
MeSH
Aged ; Area Under Curve ; Decision Support Techniques* ; Endoscopic Mucosal Resection* ; Female ; Gastrectomy* ; Gastrointestinal Hemorrhage/epidemiology ; Gastroscopy* ; Humans ; Kaplan-Meier Estimate ; Male ; Margins of Excision ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; ROC Curve ; Reproducibility of Results ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms/epidemiology ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery* ; Treatment Failure ; Tumor Burden ; Ulcer/epidemiology
Abstract
BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) is a useful method for complete resection of early gastric cancer (EGC). However, there are still some patients who undergo additional gastrectomy after ESD because of non-curative resection. There is no model that can accurately predict non-curative resection of ESD. We aimed to create a model for predicting non-curative resection of ESD in patients with EGC.

PATIENTS AND METHODS: We reviewed the medical records, including all gross findings of EGC, of patients who underwent ESD for EGCs. We divided the patients into a non-curative resection group and a curative resection group. The clinicopathologic characteristics were compared between the groups to identify the risk factors for non-curative resection of ESD. We created a scoring system based on logistic regression modeling and bootstrap validation.

RESULTS: Of 1639 patients who had undergone ESD for EGCs, 272 were identified as being treated non-curatively with ESD. A large tumor size (≥20 mm), tumor location in the upper body of the stomach, the presence of ulcer, fusion of gastric folds, the absence of mucosal nodularity, spontaneous bleeding, and undifferentiated tumor histology were associated with non-curative resection of ESD. Points of risk scores were assigned for these variables based on the β coefficient as follows: tumor size (≥20 mm), 2 points; tumor location in the upper body of the stomach, 1 point; ulcer, 2 points; fusion of gastric folds, 2 points; absence of mucosal nodularity, 1 point; spontaneous bleeding, 1 point; and undifferentiated histology, 2 points. Our risk scoring model showed good discriminatory performance on internal validation (bootstrap-corrected area under the receiver operating characteristic curve, 0.7004; 95% confidence interval, 0.6655-0.7353).

CONCLUSIONS: We developed a validated prediction model that can be used to identify patients who will undergo non-curative resection of ESD. Our prediction model can provide useful information for making decisions about the treatment of EGC before performing ESD.
Full Text
http://www.sciencedirect.com/science/article/pii/S0016510716306757
DOI
10.1016/j.gie.2016.10.018
Appears in Collections:
6. Others (기타) > Dept. of Health Promotion (건강의학과) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young Jin(김영진)
Kim, Eun Hye(김은혜) ORCID logo https://orcid.org/0000-0001-6691-6837
Kim, Ha Yan(김하얀)
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
Shin, Sung Kwan(신성관) ORCID logo https://orcid.org/0000-0001-5466-1400
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lee, Yong Kang(이용강)
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Chung, Hyun Soo(정현수)
Hahn, Kyu Yeon(한규연)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/154295
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