Clinical parameters associated with metachronous recurrence after curative endoscopic submucosal dissection for early gastric cancer
- 1ivision of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
Abstract
Although endoscopic submucosal dissection (ESD) is an established treatment for early gastric cancer (EGC), metachronous recurrence remains an important clinical issue during long-term follow-up. We evaluated clinical parameters associated with metachronous recurrence after curative ESD using the longitudinal cohort. This retrospective observational study included 1,200 patients who achieved curative resection of EGC and were followed for at least 12 months. During follow-up, 185 patients (15.4%) developed metachronous neoplasms, including 102 patients with metachronous cancer and 83 with metachronous adenoma only. The primary analysis used a Cox proportional hazards model with time from ESD to first metachronous neoplasm or censoring. In the adjusted full-cohort model, older age [hazard ratio (HR): 1.035 per year, 95% confidence interval (CI): 1.015–1.055, P < 0.001] and persistent Helicobacter pylori (H. pylori) infection (HR: 2.391, 95% CI: 1.398–4.088, P = 0.001) were independently associated with a higher hazard of metachronous neoplasm, whereas diabetes mellitus showed a borderline association (HR: 1.391, 95% CI: 0.988–1.958, P = 0.058). The estimated cumulative probability of metachronous neoplasm was 7.6% at 3 years and 12.3% at 5 years. Secondary exploratory analyses using patients who remained recurrence-free for ≥10 years as controls showed associations of age and diabetes mellitus with overall metachronous neoplasm, while age and diabetes mellitus were associated with metachronous cancer and age and lower serum albumin with metachronous adenoma. In conclusion, older age and persistent H. pylori infection were independently associated with metachronous neoplasm in the full cohort. These findings support continued surveillance after curative ESD.
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BibTeX
@article{joo2026clinical,
title = {{Clinical parameters associated with metachronous recurrence after curative endoscopic submucosal dissection for early gastric cancer}},
author = {Moon Kyung Joo and Seung Han Kim and Won Shik Kim and Beom Jae Lee},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1965395},
url = {https://doi.org/10.3389/fmed.2026.1965395},
note = {CC BY},
}
RIS
TY - JOUR
TI - Clinical parameters associated with metachronous recurrence after curative endoscopic submucosal dissection for early gastric cancer
AU - Moon Kyung Joo
AU - Seung Han Kim
AU - Won Shik Kim
AU - Beom Jae Lee
PY - 2026
DA - 2026/10/23
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1965395
UR - https://doi.org/10.3389/fmed.2026.1965395
AB - Although endoscopic submucosal dissection (ESD) is an established treatment for early gastric cancer (EGC), metachronous recurrence remains an important clinical issue during long-term follow-up. We evaluated clinical parameters associated with metachronous recurrence after curative ESD using the longitudinal cohort. This retrospective observational study included 1,200 patients who achieved curative resection of EGC and were followed for at least 12 months. During follow-up, 185 patients (15.4%) developed metachronous neoplasms, including 102 patients with metachronous cancer and 83 with metachronous adenoma only. The primary analysis used a Cox proportional hazards model with time from ESD to first metachronous neoplasm or censoring. In the adjusted full-cohort model, older age [hazard ratio (HR): 1.035 per year, 95% confidence interval (CI): 1.015–1.055, P < 0.001] and persistent Helicobacter pylori (H. pylori) infection (HR: 2.391, 95% CI: 1.398–4.088, P = 0.001) were independently associated with a higher hazard of metachronous neoplasm, whereas diabetes mellitus showed a borderline association (HR: 1.391, 95% CI: 0.988–1.958, P = 0.058). The estimated cumulative probability of metachronous neoplasm was 7.6% at 3 years and 12.3% at 5 years. Secondary exploratory analyses using patients who remained recurrence-free for ≥10 years as controls showed associations of age and diabetes mellitus with overall metachronous neoplasm, while age and diabetes mellitus were associated with metachronous cancer and age and lower serum albumin with metachronous adenoma. In conclusion, older age and persistent H. pylori infection were independently associated with metachronous neoplasm in the full cohort. These findings support continued surveillance after curative ESD.
SN - 2296-858X
ER -