title: Neutrophil infiltration and the distribution of intestinal metaplasia is associated with metachronous gastric cancer following endoscopic submucosal dissection.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) of early gastric cancer is a minimally invasive procedure. However, the risk for metachronous cancers after successful cancer treatment remains high and the risk factors for metachronous cancers have not been elucidated.
  
  
  OBJECTIVE
  To evaluate the risk factors for metachronous gastric cancers after ESD with a long-term follow-up.
  
  
  METHODS
  A total of 155 consecutive patients (119 men, 36 women, mean age 68.9 years) were treated with ESD between September 2000 and September 2009. Biopsy specimens were obtained from the greater curvature of the antrum and middle corpus to evaluate gastric mucosal status, including Helicobacter pylori, intestinal metaplasia (IM) and neutrophil infiltration (NI) before ESD. Follow-up endoscopy after ESD was scheduled at two and six months, one year and annually thereafter. H pylori eradication was recommended when possible.
  
  
  RESULTS
  The median follow-up period was 4.2 years. Metachronous gastric cancers were found in 23 of 155 patients (3.5% per year). No local recurrences were observed. The cumulative incidence of metachronous gastric cancer was significantly high in IM and NI in the corpus (P=0.0093 and P=0.0025, respectively [log-rank test]). The ORs for IM and NI in the corpus were 2.65 and 3.06, respectively, according to the Cox proportional hazards model (P=0.024 and P=0.0091, respectively).
  
  
  CONCLUSIONS
  The presence of IM and NI in the corpus was closely related to the development of metachronous gastric cancer after ESD.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yamaji
authors.forename: Kosuke
authors.initials: K
authors.lastname: Sakitani
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Isomura
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Yoshida
authors.forename: Atsuo
authors.initials: A
authors.lastname: Yamada
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Hirata
authors.forename: Keiji
authors.initials: K
authors.lastname: Ogura
authors.forename: Makoto
authors.initials: M
authors.lastname: Okamoto
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000601:surgery; D005773:Gastroscopy; D016480:Helicobacter pylori; D006801:Humans; D007422:Intestines / Q000473:pathology*; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D020556:Neutrophil Infiltration; D013274:Stomach Neoplasms / Q000276:immunology* / Q000473:pathology / Q000601:surgery