Comparable Cancer-Specific Mortality of Patients with Early Gastric Cancer Treated with Endoscopic Therapy vs Surgical Resection.
Endoscopic therapy is commonly used for superficial gastric cancer with very low risk of metastasis to the lymph nodes. However, no population-based studies from the West have compared long-term outcomes of patients who received endoscopic therapy vs surgery. We analyzed a population database to determine outcomes of patients with mucosal gastric cancer who underwent endoscopic therapy vs surgery.We used the Surveillance Epidemiology and End Results database to identify and compare features and outcomes of patients who underwent endoscopic therapy (n=786) or surgery (n=2577) for Tis or T1aN0M0 superficial gastric cancer, diagnosed from 1998 to 2014. Multivariate logistic regression was performed to identify factors associated with endoscopic therapy. Overall survival and gastric cancer-specific survival times were compared after we controlled for covariates.Use of endoscopic therapy increased from 15.1% of cases in 1998-2000 to 39.0% of cases in 2013-2014. Endoscopic therapy was used more frequently in patients who were older, female, or Caucasian, or with lesions that were located in the proximal stomach or were limited in depth (Tis vs T1a) and size, compared with surgery. The median follow-up time was 59 months (interquartile range, 31-102 months). Percentages of 5-year overall and cancer-specific survival were 57% and 99% in the endoscopic therapy group and 76% and 95% in the surgery group. After we adjusted for clinical factors using a multivariate Cox proportional hazards model, we found no significant difference in gastric cancer-specific mortality between patients who received endoscopic therapy vs surgery (hazard ratio, 1.42; 95% CI, 0.91-2.23; P=0.12).In an analysis of a large population database, we found an increased trend in endoscopic therapy for superficial gastric cancer compared with surgery, from 1998 through 2014. Patients who received endoscopic therapy vs surgery have comparable long-term cancer-specific mortality.