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[수술과 비교한 ESD의 장기성적]

1. 내시경 치료와 수술 비교 (propensity matched score analysis)

2016년 삼성서울병원에서는 조기위암 내시경치료와 수술의 장기성적 비교논문을 발표하였습니다 (Pyo JH. Am J Gastroenterol 2016). 대상환자는 2002년부터 2012년까지였습니다.

METHODS: We reviewed prospectively collected data of patients who had undergone endoscopic resection (1,290 patients) or surgery (1,273 patients) for EGC. To reduce the effect of selection bias, we performed a propensity score-matching analysis between the two groups... The study was designed as a non-inferiority study and tested in an intention-to-treat analysis.

RESULTS: In a propensity-matched analysis of 611 pairs, the 10-year OS proportion was 96.7% in the endoscopic resection group and 94.9% in the surgery group (P=0.120) (risk difference -1.8%, 95% confidence interval (CI) -4.04-0.44, Pnon-inferiority=0.014), which met the non-inferiority criterion. In contrast, the 10-year RFS proportion was 93.5% in the endoscopic resection group and 98.2% in the surgery group (P<0.001) (risk difference 4.7%, 95% CI 2.50-6.97, Pnon-inferiority=0.820), which did not meet the non-inferiority criterion, mainly because of metachronous recurrence in the endoscopic resection group. The rate of early complications was higher in the endoscopic resection group than in the surgery group (9.0 vs. 6.6%, P=0.024), whereas the rate of late complications was higher in the surgery group than in the endoscopic resection group (0.5 vs. 2.9%, P<0.001). In the multiple Cox regression analysis, patient's age, the comorbidity index, the performance index, sex, tumor morphology, and depth of invasion were predictors of OS in patients with EGC.

결과는 예상한 바대로였습니다. Overall survival은 비슷하였습니다.

Disease free survival은 metachronous recurrence 때문에 내시경치료가 조금 못하였습니다.

내시경치료와 수술을 propensity score matching analysis로 분석한 기존 연구와 크게 다르지 않은 결과였습니다.

환자 수가 많았고 추적관찰이 길었고 분석기법이 매우 detail한 점이 평가를 받은 것으로 생각됩니다. 표정의 선생님, 이혁 선생님. 좋은 연구 축하합니다.

© 일원내시경교실 바른내시경연구소 이준행. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng