Long-term Outcomes of Endoscopic Submucosal Dissection Versus Surgery in Late Older Adult Patients Aged ≥75 Years With Early Gastric Cancer Meeting the Curative Resection Criteria.

内容摘要

We compared the long-term outcomes of endoscopic submucosal dissection (ESD) with those of surgery in late older adult patients aged &#x2265;75 years with early gastric cancer (EGC) who met the curative resection criteria. This multicenter retrospective study included 4,241 older adults with EGC who were treated with either ESD (n=4,083) or surgery (n=158) at 22 hospitals between 2010 and 2020. Overall survival (OS) and gastric cancer (GC) recurrence were investigated in the overall cohort and a 4-to-1 propensity score (PS)-matched cohort. During a median follow-up of 6.6 years, the 5-year OS rates were 84.8% and 82.9% in the ESD and surgery groups, respectively, and OS did not differ between the 2 groups in the overall (P=0.396) and PS-matched cohorts (P=0.248). In the PS-matched cohort, the multivariate analyses showed that overall mortality after ESD (adjusted hazard ratio, 0.77; 95% confidence interval, 0.57-1.04) did not increase compared to that after surgery. The GC recurrence rate after ESD was higher than that after surgery (6.1% [248/4,083] vs. 0.6% [1/158]; 5-year rate: 9.3% vs. 0.7%, respectively; P<0.001 for the overall and PS-matched cohorts). However, approximately 77% (190/248) of the recurrences in the ESD group were metachronous, most of which were successfully managed with endoscopic treatment. The ESD group had fewer adverse events (AEs, 7.6% vs. 12.0%; P=0.044) than the surgery group, and no ESD treatment-related deaths were observed. In late older adult patients (aged &#x2265;75 years) with EGC, long-term outcomes after ESD were comparable to those after surgery for EGC meeting the curative resection criteria, with acceptable treatment-related AEs.