Endoscopic Features of Synchronous Multiple Early Gastric Cancers: Findings from a Nationwide Cohort

Yoshito Hayashi¹, Waku Hatta², Yosuke Tsuji³, Toshiyuki Yoshio⁴, Yohei Yabuuchi^{5

6}, Shu Hoteya⁷, Shigetsugu Tsuji⁸, Yasuaki Nagami⁹, Takuto Hikichi¹⁰, Masakuni Kobayashi¹¹, Yoshinori Morita^{12

13}, Tetsuya Sumiyoshi¹⁴, Mikitaka Iguchi¹⁵, Hideomi Tomida^{16

17}, Takuya Inoue¹⁸, Tatsuya Mikami¹⁹, Kenkei Hasatani²⁰, Jun Nishikawa²¹, Tomoaki Matsumura²², Hiroko Nebiki²³, Dai Nakamatsu²⁴, Ken Ohnita²⁵, Haruhisa Suzuki²⁶, Hiroya Ueyama²⁷, Mitsushige Sugimoto^{28

29}, Shinjiro Yamaguchi³⁰, Tomoki Michida^{31

32}, Tomoyuki Yada³³, Yoshiro Asahina³⁴, Toshiaki Narasaka³⁵, Shiko Kuribayashi³⁶, Shu Kiyotoki³⁷, Katsuhiro Mabe^{38

39}, Hiroyuki Kurakami⁴⁰, Mitsuhiro Fujishiro³, Atsushi Masamune², Tetsuo Takehara⁴¹

Affiliations

¹ Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan, y.hayashi@gh.med.osaka-u.ac.jp.
² Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
³ Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁴ Division of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
⁵ Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Japan.
⁶ Department of Gastroenterology, Kobe City Medical Center General Hospital, Kobe, Japan.
⁷ Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
⁸ Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
⁹ Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
¹⁰ Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.
¹¹ Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
¹² Department of Gastroenterology, Kobe University International Clinical Cancer Research Center, Kobe, Japan.
¹³ Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan.
¹⁴ Department of Gastroenterology, Tonan Hospital, Sapporo, Japan.
¹⁵ Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
¹⁶ Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
¹⁷ Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan.
¹⁸ Division of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan.
¹⁹ Division of Endoscopy, Hirosaki University Hospital, Hirosaki, Japan.
²⁰ Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan.
²¹ Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan.
²² Department of Gastroenterology, Chiba University Graduate School of Medicine, Chiba, Japan.
²³ Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan.
²⁴ Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan.
²⁵ Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.
²⁶ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
²⁷ Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
²⁸ Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Kusatsu, Japan.
²⁹ Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan.
³⁰ Division of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Japan.
³¹ Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama, Japan.
³² Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
³³ Division of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Japan.
³⁴ Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.
³⁵ Division of Endoscopic Center, University of Tsukuba Hospital, Tsukuba, Japan.
³⁶ Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan.
³⁷ Department of Gastroenterology, Shuto General Hospital, Yanai, Japan.
³⁸ Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan.
³⁹ Junpukai Health Maintenance Center Kurashiki, Kurashiki, Japan.
⁴⁰ Institute for Clinical Translational Science, Nara Medical University, Kashihara, Japan.
⁴¹ Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan.

PMID: 38697038
DOI: 10.1159/000538941

Endoscopic Features of Synchronous Multiple Early Gastric Cancers: Findings from a Nationwide Cohort

Yoshito Hayashi et al. Digestion. 2024.

. 2024;105(4):266-279.

doi: 10.1159/000538941. Epub 2024 May 2.

Authors

Affiliations

¹ Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan, y.hayashi@gh.med.osaka-u.ac.jp.
² Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
³ Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁴ Division of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
⁵ Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Japan.
⁶ Department of Gastroenterology, Kobe City Medical Center General Hospital, Kobe, Japan.
⁷ Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
⁸ Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
⁹ Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
¹⁰ Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.
¹¹ Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
¹² Department of Gastroenterology, Kobe University International Clinical Cancer Research Center, Kobe, Japan.
¹³ Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan.
¹⁴ Department of Gastroenterology, Tonan Hospital, Sapporo, Japan.
¹⁵ Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
¹⁶ Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
¹⁷ Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan.
¹⁸ Division of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan.
¹⁹ Division of Endoscopy, Hirosaki University Hospital, Hirosaki, Japan.
²⁰ Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan.
²¹ Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan.
²² Department of Gastroenterology, Chiba University Graduate School of Medicine, Chiba, Japan.
²³ Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan.
²⁴ Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan.
²⁵ Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.
²⁶ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
²⁷ Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
²⁸ Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Kusatsu, Japan.
²⁹ Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan.
³⁰ Division of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Japan.
³¹ Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama, Japan.
³² Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
³³ Division of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Japan.
³⁴ Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.
³⁵ Division of Endoscopic Center, University of Tsukuba Hospital, Tsukuba, Japan.
³⁶ Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan.
³⁷ Department of Gastroenterology, Shuto General Hospital, Yanai, Japan.
³⁸ Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan.
³⁹ Junpukai Health Maintenance Center Kurashiki, Kurashiki, Japan.
⁴⁰ Institute for Clinical Translational Science, Nara Medical University, Kashihara, Japan.
⁴¹ Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan.

PMID: 38697038
DOI: 10.1159/000538941

Abstract

Introduction: We investigated the factors associated with synchronous multiple early gastric cancers and determined their localization.

Methods: We analyzed 8,191 patients who underwent endoscopic submucosal dissection for early gastric cancers at 33 hospitals in Japan from November 2013 to October 2016. Background factors were compared between single-lesion (n = 7,221) and synchronous multi-lesion cases (n = 970) using univariate and multivariate analyses. We extracted cases with two synchronous lesions (n = 832) and evaluated their localization.

Results: Significant independent risk factors for synchronous multiple early gastric cancer were older age (≥75 years old) (odds ratio [OR] = 1.257), male sex (OR = 1.385), severe mucosal atrophy (OR = 1.400), tumor localization in the middle (OR = 1.362) or lower region (OR = 1.404), and submucosal invasion (OR = 1.528 [SM1], 1.488 [SM2]). Depressed macroscopic type (OR = 0.679) and pure undifferentiated histology OR = 0.334) were more common in single early gastric cancers. When one lesion was in the upper region, the other was more frequently located in the lesser curvature of the middle region. When one lesion was in the middle region, the other was more frequently located in the middle region or the lesser curvature of the lower region. When one lesion was in the lower region, the other was more frequently located in the lesser curvature of the middle region or the lower region.

Conclusion: Factors associated with synchronous multiple early gastric cancer included older age, male sex, severe mucosal atrophy, tumor localization in the middle or lower region, and tumor submucosal invasion. Our findings provide useful information regarding specific areas that should be examined carefully when one lesion is detected.

Keywords: Endoscopic submucosal dissection; Gastric mucosal atrophy; Helicobacter pylori; Synchronous multiple early gastric cancer; Tumor localization.

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Endoscopic Features of Synchronous Multiple Early Gastric Cancers: Findings from a Nationwide Cohort

Affiliations

Endoscopic Features of Synchronous Multiple Early Gastric Cancers: Findings from a Nationwide Cohort

Authors

Affiliations

Abstract

MeSH terms

LinkOut - more resources

Full Text Sources

Medical