title: The superficial elevated and depressed lesion type is an independent factor associated with non-curative endoscopic submucosal dissection for early gastric cancer.
abstract: The expanded criteria for endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) have led to an increase in the number of EGC patients who receive curative treatment involving endoscopic techniques. Identifying the factors that are associated with treatment outcomes would be helpful in the application of ESD for EGC.
  
  
  
  Potential factors associated with incomplete ESD and with non-curative ESD were investigated using a multiple logistic regression model in EGC patients who consecutively underwent ESD according to the expanded criteria.
  
  
  
  A total of 363 patients with 398 EGC lesions were enrolled. The rates of complete ESD and curative ESD were 96.2 % (383/398) and 85.7 % (341/398), respectively. No significant factors associated with incomplete ESD were identified. In contrast, a tumor size >20 mm [odds ratio (OR) 3.31; 95 % confidence interval (CI) 1.74-6.29], the superficial elevated and depressed type (0-IIa + IIc or IIc + IIa) (OR 4.37; 95 % CI 1.88-9.88), and the undifferentiated type (OR 5.93; 95 % CI 1.65-19.41) were identified as independent factors associated with non-curative ESD. The superficial elevated and depressed type in particular was found to be highly related to submucosal and lymphovascular invasion. The rate of non-curative ESD in cases of this macroscopic type occurring together with a tumor size >20 mm was 58.3 %, and the adjusted OR was 16.48 (95 % CI 4.69-62.09).
  
  
  
  The results suggest that the superficial elevated and depressed type is an independent factor associated with non-curative ESD and that the risk of non-curative ESD is increased when this macroscopic type is present along with a large tumor size.
authors.affiliation: Department of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University Hospital, Kobe, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Ohara
authors.affiliation: Department of Hepatology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa, 920-029, Japan. n.toshikuni@gmail.com.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Toshikuni
authors.affiliation: Department of Gastroenterology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Matsueda
authors.affiliation: Department of Gastroenterology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Mouri
authors.affiliation: Department of Gastroenterology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Early gastric cancer; Endoscopic submucosal dissection; Macroscopic type