Risk assessment chart for curability of early gastric cancer with endoscopic submucosal dissection

Background: Endoscopic submucosal dissection (ESD) was introduced worldwide as a new treatment option for early gastric cancer, but curability prediction has not been evaluated on an individual basis.

Objective: To analyze factors contributing to the curability of early gastric cancer after ESD and to construct a risk assessment chart for the probability of curability.

Design: Single-institution retrospective review.

Setting: University hospital.

Patients: From June 2000 to April 2010, we treated 961 early gastric cancers in 784 patients (mean age 70.2 years).

Intervention: ESD procedures were performed using typical sequences.

Main outcome measurements: Risk factors related to resectability (en bloc or piecemeal resection) and curability (curative or noncurative resection) after ESD were analyzed using logistic regression analysis. Using this model, we constructed a risk assessment chart to predict the probability of noncurability from patient characteristics.

Results: The en bloc and curative resection rates were 98.9% and 88.1%, respectively, after ESD. Significant contributors to noncurative ESD were large lesions, upper location, and ulcer findings. Predicted noncurability probabilities were displayed in 4 colors for each risk level (light blue, blue, yellow, and red) by combining tumor size, tumor location, and ulcer findings. Probability of noncurability was highest (≥ 40%) in ulcerative large tumors (>30 mm in diameter) in the upper location (red) and lowest in nonulcerative small tumors (≤ 20 mm in diameter) in the lower location (light blue).

Limitations: Retrospective design and single-site data collection.

Conclusions: This risk assessment chart shows individuals their pretreatment curability assessment with successful ESD and may be an educational tool for trainees or a decision-making tool.