S1408 Endoscopic Submucosal Dissection versus Surgery for Early Gastric Cancer With Undifferentiated Type Histology: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Introduction: Endoscopic submucosal dissection (ESD) is considered a standard treatment for early gastric cancer (EGC). However, its indication for the management of undifferentiated EGC is controversial. We compared the short- and long-term outcomes of ESD vs. surgery in the management of undifferentiated EGC. Methods: We performed a systematic review until March 2021 for studies assessing patients with undifferentiated EGC that met expanded indication and who were treated with ESD or surgery. Databases included Medline, Embase, Scopus, and Web of Science. The primary outcome was all-cause mortality. Secondary outcomes were complete histological, overall complication and recurrence rate. Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of studies. Random effects meta-analyses were conducted, and effects shown as relative risks (RR) and their 95% confidence intervals (CIs). Results: Seven studies were included in the final analysis, with 755 and 1882 patients treated by ESD and surgery, respectively. All studies were Asian (six from Korea and one from China). Use of ESD was associated with an increased all-cause mortality (RR, 2.17; 95% CI, 1.24–3.81; p < 0.01). Furthermore, surgery was associated with lower risk of any recurrence (RR, 5.24; 95% CI, 1.49–18.46; p=0.01). No significant difference was found in the complete histological resection rate (RR, 0.94; 95% CI, 0.89–1.00; p=0.05) and in overall complication rate (RR, 1.01; 95% CI, 0.27–3.69; p=0.99) between the ESD and surgery groups. The risk of all-cause mortality was not significant if only the two studies performing propensity score matching were included (RR, 2.28; 95% CI, 0.95–5.47; p=0.06). If studies enrolling only patients with curative resections are included (two studies), all-cause mortality wsas higher in the ESD group (RR, 2.28; 95% CI, 1.18–4.39; p=0.01), but the risk of recurrence was similar (RR, 8.44; 95% CI, 0.43–166.81; p=0.16). Conclusion: Surgical treatment appears to be preferable for undifferentiated EGC. However, a strict and careful patient selection for ESD and meticulous surveillance after a curative resection could propose ESD as an alternative treatment.Figure 1.: a. Forest plot of All-cause mortality comparing endoscopic submucosal dissection (ESD) and surgery. b. Forest plot of Any recurrence comparing ESD and surgery CI, confidence interval.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.028 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.039 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".