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Long-term Survival Following Endoscopic Submucosal Dissection Versus Gastrectomy in Early Gastric Cancer Patients Aged 75 Years and Above: A National Retrospective Cohort Study in Korea.

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  • Additional Information
    • Source:
      Publisher: Korean Gastric Cancer Association Country of Publication: Korea (South) NLM ID: 101559430 Publication Model: Print Cited Medium: Internet ISSN: 2093-5641 (Electronic) Linking ISSN: 15981320 NLM ISO Abbreviation: J Gastric Cancer Subsets: MEDLINE
    • Publication Information:
      Original Publication: Seoul : Korean Gastric Cancer Association
    • Subject Terms:
      Stomach Neoplasms*/diagnosis ; Stomach Neoplasms*/mortality ; Stomach Neoplasms*/pathology ; Stomach Neoplasms*/surgery ; Gastrectomy*/statistics & numerical data ; Endoscopic Mucosal Resection*/statistics & numerical data; Republic of Korea/epidemiology ; Stomach/pathology ; Stomach/surgery ; Gastric Mucosa/pathology ; Gastric Mucosa/surgery ; Retrospective Studies ; Neoplasm Staging ; Survival Rate ; Age Factors ; Humans ; Male ; Female ; Aged ; Aged, 80 and over ; Treatment Outcome ; Follow-Up Studies
    • Abstract:
      Purpose: Despite a growing older adult population, few studies have compared the long-term outcomes of endoscopic submucosal dissection (ESD) with those of gastrectomy. This study examines long-term survival among older patients with early gastric cancer (EGC) treated with ESD versus gastrectomy.
      Materials and Methods: This retrospective cohort study used data from the Korea Clinical Data Utilization Network for Research Excellence. Patients aged ≥75 with stage IA gastric cancer (diagnosed 2014-2015) who underwent ESD or gastrectomy were followed for 5 years. All-cause and cause-specific mortality were assessed using Cox proportional hazard models and propensity score matching.
      Results: Of the 442 patients (ESD, 269; gastrectomy, 173), the 5-year overall survival rates were 85.9% for ESD and 80.9% for gastrectomy (P=0.140). In patients aged ≥80, gastrectomy showed higher risks of total (adjusted hazard ratio [aHR], 3.29; 95% CI, 1.70-6.35) and gastric cancer-specific death (aHR, 7.18; 95% CI, 2.08-24.82) compared with ESD. In mucosa-confined lesions, gastrectomy also showed increased gastric cancer-specific mortality (aHR, 6.11; 95% CI, 1.93-19.35). The survival benefit of ESD was comparable to that of gastrectomy among patients aged 75-79 years and those with confined submucosal lesions.
      Conclusions: ESD may offer better outcomes than gastrectomy among older patients with stage IA gastric cancer, particularly those aged ≥80 or with mucosa-confined lesions. ESD and gastrectomy may provide similar survival outcomes among patients aged 75-79 years and those with submucosa-confined lesions. These findings support the use of adaptive treatment strategies in older patients with EGC.
      (Copyright © 2025. Korean Gastric Cancer Association.)
    • Abstract:
      No potential conflict of interest relevant to this article was reported.
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    • Grant Information:
      NA23-001 NECA; 2510673-1 National Cancer Center
    • Contributed Indexing:
      Keywords: Aged; Endoscopic mucosal resection; Gastrectomy; Stomach neoplasms; Survival rate
    • Publication Date:
      Date Created: 20251015 Date Completed: 20251226 Latest Revision: 20260312
    • Publication Date:
      20260313
    • Accession Number:
      PMC12536195
    • Accession Number:
      10.5230/jgc.2025.25.e41
    • Accession Number:
      41093776