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

 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 
 Gastrointestinal Endoscopy, Vol.85(5) : 976-983, 2017 
Journal Title
 Gastrointestinal Endoscopy 
Issue Date
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
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
김영진(Kim, Young Jin)
김은혜(Kim, Eun Hye) ORCID logo https://orcid.org/0000-0001-6691-6837
김하얀(Kim, Ha Yan)
박준철(Park, Jun Chul) ORCID logo https://orcid.org/0000-0001-8018-0010
신성관(Shin, Sung Kwan)
이상길(Lee, Sang Kil) ORCID logo https://orcid.org/0000-0002-0721-0364
이용강(Lee, Yong Kang)
이용찬(Lee, Yong Chan)
정현수(Chung, Hyun Soo)
한규연(Hahn, Kyu Yeon)
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