Risk factor-based optimal endoscopic surveillance intervals after endoscopic submucosal dissection for gastric adenoma

Abstract To date, there exists no established endoscopic surveillance interval strategy after endoscopic submucosal dissection (ESD) for gastric adenoma. In this study, we suggest a risk factor-based statistical model for optimal surveillance intervals for gastric adenoma after ESD with curative res...

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Main Authors: Choong-Kyun Noh, Eunyoung Lee, Gil Ho Lee, Sun Gyo Lim, Kee Myung Lee, Jin Roh, Young Bae Kim, Bumhee Park, Sung Jae Shin
Format: Article
Language:English
Published: Nature Portfolio 2021-11-01
Series:Scientific Reports
Online Access:https://doi.org/10.1038/s41598-021-00969-1
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author Choong-Kyun Noh
Eunyoung Lee
Gil Ho Lee
Sun Gyo Lim
Kee Myung Lee
Jin Roh
Young Bae Kim
Bumhee Park
Sung Jae Shin
author_facet Choong-Kyun Noh
Eunyoung Lee
Gil Ho Lee
Sun Gyo Lim
Kee Myung Lee
Jin Roh
Young Bae Kim
Bumhee Park
Sung Jae Shin
author_sort Choong-Kyun Noh
collection DOAJ
description Abstract To date, there exists no established endoscopic surveillance interval strategy after endoscopic submucosal dissection (ESD) for gastric adenoma. In this study, we suggest a risk factor-based statistical model for optimal surveillance intervals for gastric adenoma after ESD with curative resection. A cox proportional hazard model was applied to identify risk factors for recurrence after ESD. Patients (n = 698) were categorized into groups based on the identified risk factors. The cumulative density of recurrence over time was computed using a cubic splined baseline hazard function, and the customized surveillance interval was modeled for each risk group. The overall cumulative incidence of recurrence was 7.3% (n = 51). Risk factors associated with recurrence were male (hazard ratio [HR], 2.60, P = 0.030), protruded scar (HR, 3.18, P < 0.001), and age ≥ 59 years (HR, 1.05, P < 0.001). The surveillance interval for each group was developed by using the recurrence limit for the generated risk groups. According to the developed schedule, high-risk patients would have a maximum of seven surveillance visits for 5 years, whereas low-risk patients would have biennial surveillance for cancer screening. We proposed a simple and promising strategy for determining a better endoscopic surveillance interval by parameterizing diverse and group-specific recurrence risk factors into a well-known survival model.
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spelling doaj.art-fc917f50c1a1402bafeff661f688e6d42022-12-21T20:29:13ZengNature PortfolioScientific Reports2045-23222021-11-0111111010.1038/s41598-021-00969-1Risk factor-based optimal endoscopic surveillance intervals after endoscopic submucosal dissection for gastric adenomaChoong-Kyun Noh0Eunyoung Lee1Gil Ho Lee2Sun Gyo Lim3Kee Myung Lee4Jin Roh5Young Bae Kim6Bumhee Park7Sung Jae Shin8Department of Gastroenterology, Ajou University School of MedicineDepartment of Biomedical Informatics, Ajou University School of MedicineDepartment of Gastroenterology, Ajou University School of MedicineDepartment of Gastroenterology, Ajou University School of MedicineDepartment of Gastroenterology, Ajou University School of MedicineDepartment of Pathology, Ajou University School of MedicineDepartment of Pathology, Ajou University School of MedicineDepartment of Biomedical Informatics, Ajou University School of MedicineDepartment of Gastroenterology, Ajou University School of MedicineAbstract To date, there exists no established endoscopic surveillance interval strategy after endoscopic submucosal dissection (ESD) for gastric adenoma. In this study, we suggest a risk factor-based statistical model for optimal surveillance intervals for gastric adenoma after ESD with curative resection. A cox proportional hazard model was applied to identify risk factors for recurrence after ESD. Patients (n = 698) were categorized into groups based on the identified risk factors. The cumulative density of recurrence over time was computed using a cubic splined baseline hazard function, and the customized surveillance interval was modeled for each risk group. The overall cumulative incidence of recurrence was 7.3% (n = 51). Risk factors associated with recurrence were male (hazard ratio [HR], 2.60, P = 0.030), protruded scar (HR, 3.18, P < 0.001), and age ≥ 59 years (HR, 1.05, P < 0.001). The surveillance interval for each group was developed by using the recurrence limit for the generated risk groups. According to the developed schedule, high-risk patients would have a maximum of seven surveillance visits for 5 years, whereas low-risk patients would have biennial surveillance for cancer screening. We proposed a simple and promising strategy for determining a better endoscopic surveillance interval by parameterizing diverse and group-specific recurrence risk factors into a well-known survival model.https://doi.org/10.1038/s41598-021-00969-1
spellingShingle Choong-Kyun Noh
Eunyoung Lee
Gil Ho Lee
Sun Gyo Lim
Kee Myung Lee
Jin Roh
Young Bae Kim
Bumhee Park
Sung Jae Shin
Risk factor-based optimal endoscopic surveillance intervals after endoscopic submucosal dissection for gastric adenoma
Scientific Reports
title Risk factor-based optimal endoscopic surveillance intervals after endoscopic submucosal dissection for gastric adenoma
title_full Risk factor-based optimal endoscopic surveillance intervals after endoscopic submucosal dissection for gastric adenoma
title_fullStr Risk factor-based optimal endoscopic surveillance intervals after endoscopic submucosal dissection for gastric adenoma
title_full_unstemmed Risk factor-based optimal endoscopic surveillance intervals after endoscopic submucosal dissection for gastric adenoma
title_short Risk factor-based optimal endoscopic surveillance intervals after endoscopic submucosal dissection for gastric adenoma
title_sort risk factor based optimal endoscopic surveillance intervals after endoscopic submucosal dissection for gastric adenoma
url https://doi.org/10.1038/s41598-021-00969-1
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