title: Outcomes of ESD for patients with early gastric cancer and comorbid liver cirrhosis: a propensity score analysis.
abstract: BACKGROUND
  Gastric cancer and liver cirrhosis (LC) are often comorbid. However, little is known about the clinical outcomes of gastric endoscopic submucosal dissection (ESD) in patients with comorbid LC.
  
  
  METHODS
  This case-control study used a multicentre retrospective cohort. We identified 69 LC patients from the cohort of patients with early gastric cancer, who underwent gastric ESD at 12 hospitals from March 2003 to November 2010. Using the propensity score matching method, 69 patients without LC were used to compare the short- and long-term outcomes of ESD.
  
  
  RESULTS
  Among the 69 LC patients, 53 (77 %) were Child-Pugh grade A (CP-A) and 16 (28 %) had past or present histories of hepatocellular carcinoma (HCC). Short-term outcomes did not differ between the LC patients and controls or between the CP-A and CP-B/C patients. Although the LC patients had significantly worse long-term outcomes than the controls (the 5-year overall survival rates were 60 vs. 91 %, respectively), patients with CP-A liver function without HCC histories had an overall survival almost equivalent to that of patients without LC (controls).
  
  
  CONCLUSIONS
  LC patients appear to be good candidates for ESD if they have CP-A liver function and no history of HCC. Although their short-term outcomes were not inferior, the patients with Child-Pugh grades B/C or with histories of HCC benefited less from ESD.
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan, moto28hiko@icloud.com.
authors.forename: Motohiko
authors.initials: M
authors.lastname: Kato
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nishida
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Hamasaki
authors.forename: Naoki
authors.initials: N
authors.lastname: Kawai
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Yoshio
authors.forename: Satoshi
authors.initials: S
authors.lastname: Egawa
authors.forename: Katsumi
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Hideharu
authors.initials: H
authors.lastname: Ogiyama
authors.forename: Masato
authors.initials: M
authors.lastname: Komori
authors.forename: Masanori
authors.initials: M
authors.lastname: Nakahara
authors.forename: Takamasa
authors.initials: T
authors.lastname: Yabuta
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nishihara
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Takuya
authors.initials: T
authors.lastname: Yamada
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Takehara
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications; D016022:Case-Control Studies; D004210:Dissection / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D008113:Liver Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome