Impact of Comorbidities, Sarcopenia, and Nutritional Status on the Long-Term Outcomes after Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly Patients Aged ≥ 80 Years
Abstract
:Simple Summary
Abstract
1. Introduction
2. Methods
2.1. Study Populations and Data Collection
2.2. Endoscopic Submucosal Dissection
2.3. Histopathologic Evaluation
2.4. Definitions
2.5. Measurement of Body Composition
2.6. Follow-Up Protocol and Outcome Assessment
2.7. Statistical Analysis
3. Results
3.1. Baseline Clinicopathologic Characteristics
3.2. Short-Term Outcomes
3.3. Long-Term Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | Total (n = 280) |
---|---|
Age (years), median (range) | 82 (80–92) |
Male sex, n (%) | 182 (65) |
ECOG performance status, n (%) | |
0,1,2 | 214 (76.4) |
3,4 | 66 (23.6) |
Comorbidity (with overlap) n (%) | |
Hypertension | 170 (60.7) |
Diabetes mellitus | 49 (17.5) |
Cardiac disease | 49 (17.5) |
Cerebrovascular disease | 17 (6.1) |
Liver cirrhosis | 5 (1.8) |
Chronic kidney disease | 7 (2.5) |
Respiratory disease | 28 (10) |
Malignancy in other organs | 23 (8.2) |
ASA class, n (%) | |
1,2 | 188 (67.1) |
3,4, or above | 92 (32.9) |
Charlson comorbidity index, n (%) | |
0 | 132 (47.1) |
1 | 56 (20.0) |
2 | 56 (20.0) |
3 | 23 (8.7) |
4 | 7 (2.5) |
5 or above | 6 (2.4) |
Use of antithrombotic agents, n (%) | 74 (26.4) |
Body mass index (mean, ± SD, kg/m2) | 23.3 ± 3.4 |
Prognostic nutritional index (mean, ± SD) | 46.7 ± 4.8 |
SMA index (mean, ± SD) | 45.6 ± 6.9 |
Visceral fat area (mean, ± SD, cm2) | 120.2 ± 70.5 |
Sarcopenia, n (%) | 173 (61.8) |
Visceral obesity, n (%) | 142 (50.7) |
VFA/SMA index ratio, median (range) | 2.6 (0.2–6.3) |
Sarcopenic obesity, n (%) | 106 (37.9) |
Variables | Total (n = 289) |
---|---|
Tumor size (mm), median (range) | 20 (3–85) |
Location, n (%) | |
Lower | 199 (68.9) |
Middle | 58 (20.1) |
Upper | 32 (11.1) |
Morphology of tumor, n (%) | |
Elevated | 108 (37.4) |
Flat | 40 (13.8) |
Depressed | 141 (48.8) |
Histologic type, n (%) | |
Differentiated | 263 (91.0) |
Undifferentiated | 26 (9.0) |
Depth of tumor, n (%) | |
Mucosa | 214 (74.0) |
Submucosa, SM1 | 41 (14.2) |
Submucosa, SM2 | 34 (11.8) |
Presence of ulcer findings, n (%) | 19 (6.6) |
Lymphovascular invasion, n (%) | 30 (10.4) |
Indication criteria, n (%) | |
Absolute indication | 118 (40.8) |
Expanded indication | 88 (30.4) |
Out of indication | 83 (28.7) |
Variables | Total (n = 280) |
---|---|
Procedure time (min), median (range) | 25 (4–180) |
En bloc resection, n/N (%) | 287/289 (99.3) |
R0 resection, n/N (%) | 260/289 (90.0) |
Curative resection, n/N (%) | 200/289 (69.2) |
Cause of non-curative resection (with overlap), n/N (%) | |
Positive lateral margin | 16/89 (18.0) |
Positive deep margin | 13/89 (14.6) |
Deep submucosal invasion | 33/89 (37.1) |
Lymphovascular invasion | 30/89 (33.7) |
Piecemeal resection | 1/89 (0.3) |
Adverse events of 285 ESD sessions, n/N (%) | |
Post-ESD Bleeding | 17/285 (5.9) |
Perforation | 6/285 (2.1) |
Fever | 23/285 (8.1) |
Pneumonia | 1/285 (0.3) |
Stricture | 4/285 (1.4) |
Treatment-related death | 0 |
Hospital stay (day), median (range) | 3 (2–15) |
Additional surgery in patients with/ non-curative resection, n/N (%) | 6/89 (5.6) |
Variables | Total (n = 280) |
---|---|
Follow-up period (months), median (range) | 70.5 (4–174) |
Local recurrence, n/N (%) | 1/280 (0.3) |
Metachronous recurrence, n/N (%) | 19/280 (6.8) |
Extragastric recurrence, n/N (%) | 4/280 (1.4) |
With intragastric lesion | 2/280 (0.7) |
Without intragastric lesion | 2/280 (0.7) |
Number of deaths, n/N (%) | 114/280 (40.7) |
Cause of death, n/N (%) | |
Gastric cancer | 4/114 (3.5) |
Other | 110/114 (96.5) |
Univariate | Multivariable | |||
---|---|---|---|---|
Variables | HR (95% CI) | p Value | HR (95% CI) | p Value |
Age | 1.07 (1.0–1.15) | 0.052 | 1.05 (0.97–1.12) | 0.241 |
Male, sex | 0.79 (0.52–1.19) | 0.261 | ||
ECOG performance status | ||||
0–1 | 1 | |||
2 or above | 1.4 (0.91–2.15) | 0.122 | ||
CCI | 1.23 (1.06–1.41) | 0.005 | 1.19 (1.03–1.37) | 0.018 |
PNI | 0.93 (0.89–0.97) | <0.001 | 0.93 (0.90–0.98) | 0.002 |
BMI | 0.99 (0.93–1.04) | 0.632 | ||
Use of antithrombotic agents | 1.15 (0.75–1.76) | 0.511 | ||
Tumor size | 1.0 (0.99–1.02) | 0.516 | ||
Location | 0.13 | |||
Lower | 1 | |||
Mid | 1.28 (0.81–2.04) | 0.289 | ||
Upper | 1.81 (1.01–3.23) | 0.045 | ||
Depth of invasion | 0.175 | |||
Mucosa | 1 | |||
SM1 | 1.45 (0.90–2.34) | 0.13 | ||
SM2 | 0.77 (0.43–1.40) | 0.394 | ||
Indication of ESD | 0.862 | |||
Absolute | 1 | |||
Expanded | 0.90 (0.57–1.41) | 0.624 | ||
Out of indication | 1.0 (0.64–1.56) | 0.875 | ||
Differentiation | ||||
Differentiated | 1 | |||
Undifferentiated | 0.94 (0.48–1.86) | 0.86 | ||
Lymphovascular invasion | ||||
Absent | 1 | |||
Present | 1.29 (0.75–2.23) | 0.359 | ||
Curability | ||||
Curative resection | 1 | |||
Non-curative resection | 1.02 (0.68–1.52) | 0.934 | ||
Sarcopenia | 1.51 (1.01–2.27) | 0.048 | 1.27 (0.84–1.92) | 0.266 |
Visceral obesity | 0.97 (0.67–1.40) | 0.854 | ||
Sarcopenic obesity | 0.99 (0.67–1.45) | 0.887 |
Case No | Sex/ Age | Lesion Size (mm) | Differentiation | Tumor Depth | Resection Margin | LVI | Indication | Sarcopenia | Recurrence | ||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Delay (Months) | Site | Characteristics | Management | Survival after Detection (Months) | |||||||||
1 | F/85 | 60 | M/D | SM2 | R0 | Yes | Out of indication | No | 66 | Lymph node, liver, peritoneum | Extragastric w/o intragastric lesion | Gastrectomy with LND RT | 37 |
2 | F/81 | 15 | W/D | SM2 | R0 | No | Out of indication | No | 36 | Lymph node, stomach | Extragastric with intragastric lesion | Supportive care | 37 |
3 | F/81 | 25 | M/D | SM2 | R0 | Yes | Out of indication | Yes | 23 | Lymph node | Extragastric w/o intragastric lesion | Supportive care | 3 |
4 | F/86 | 16 | P/D | SM2 | R1 | No | Out of indication | Yes | 38 | Lymph node, stomach | Extragastric w/o intragastric lesion | Supportive care | 1 |
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Kim, G.H.; Choi, K.D.; Ko, Y.; Park, T.; Kim, K.W.; Park, S.Y.; Na, H.K.; Ahn, J.Y.; Lee, J.H.; Jung, K.W.; et al. Impact of Comorbidities, Sarcopenia, and Nutritional Status on the Long-Term Outcomes after Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly Patients Aged ≥ 80 Years. Cancers 2021, 13, 3598. https://doi.org/10.3390/cancers13143598
Kim GH, Choi KD, Ko Y, Park T, Kim KW, Park SY, Na HK, Ahn JY, Lee JH, Jung KW, et al. Impact of Comorbidities, Sarcopenia, and Nutritional Status on the Long-Term Outcomes after Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly Patients Aged ≥ 80 Years. Cancers. 2021; 13(14):3598. https://doi.org/10.3390/cancers13143598
Chicago/Turabian StyleKim, Ga Hee, Kee Don Choi, Yousun Ko, Taeyong Park, Kyung Won Kim, Seo Young Park, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Kee Wook Jung, and et al. 2021. "Impact of Comorbidities, Sarcopenia, and Nutritional Status on the Long-Term Outcomes after Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly Patients Aged ≥ 80 Years" Cancers 13, no. 14: 3598. https://doi.org/10.3390/cancers13143598