White Globe Appearance Is an Endoscopic Predictor of Metachronous Multiple Gastric Cancers.
WGA positivity may indicate a higher risk for metachronous gastric cancers, suggesting that patients with WGA-positive gastric cancer should have more vigilant endoscopic follow-up.
Where it sits
this study against the rest of the teriparatide (pth 1-34) corpusSummary and findings
This study examined the association between white globe appearance (WGA) and the incidence of metachronous gastric cancers in patients who underwent endoscopic submucosal dissection for gastric cancer. A total of 444 cases were analyzed, with 160 classified as WGA-positive and 284 as WGA-negative. The findings indicated that metachronous gastric cancers were significantly more frequent in the WGA-positive group.
Abstract
<h4>Objectives</h4>White globe appearance (WGA) is a small white lesion with a globular shape identified during magnifying endoscopy with narrow-band imaging. However, the association between WGA and metachronous gastric cancer remains unclear.<h4>Methods</h4>This study involved patients who underwent endoscopic submucosal dissection (ESD) for first-episode single gastric cancer at our institution between January 2012 and December 2018 and who had at least one endoscopic follow-up after resection. WGA-positive gastric cancer was defined by the presence of WGA, and metachronous gastric cancer was defined as new cancer arising at a different site ≥1 year after ESD. The primary endpoint was a comparison of the incidence of metachronous gastric cancers in patients with WGA-positive versus WGA-negative gastric cancer. Univariate and multivariate analyses were conducted using the following variables: WGA status, sex, age, and severe atrophy.<h4>Results</h4>In total, 160 WGA-positive and 284 WGA-negative gastric cancer cases were included. Metachronous gastric cancers were significantly more frequent in the WGA-positive group (<i>p</i> < 0.01). Univariate analysis identified <i>Helicobacter pylori</i> infection (<i>p</i> = 0.049), WGA positivity (<i>p</i> < 0.01), and a longer observation period (<i>p</i> < 0.01) as factors significantly associated with metachronous gastric cancers. In the multivariate analysis, only WGA positivity was a significant independent risk factor (<i>p</i> < 0.01).<h4>Conclusions</h4>WGA may be a predictive marker for metachronous gastric cancers. In cases of WGA-positive gastric cancer, endoscopic follow-up should be conducted with heightened attention to the risk of metachronous lesions.
Background
This paper addresses the potential predictive value of white globe appearance (WGA) for metachronous gastric cancers. Previous studies have indicated that WGA may be associated with gastric cancer, but the specific relationship with metachronous cancers has not been clearly established. Understanding this association could enhance surveillance strategies for patients with gastric cancer.
Methods
The study involved patients who underwent endoscopic submucosal dissection for first-episode single gastric cancer between January 2012 and December 2018, with at least one endoscopic follow-up after resection. A total of 444 cases were analyzed, with WGA-positive defined by the presence of WGA. The primary endpoint was the comparison of metachronous gastric cancer incidence between WGA-positive and WGA-negative groups.
Results
In total, 160 WGA-positive and 284 WGA-negative gastric cancer cases were included. Metachronous gastric cancers were significantly more frequent in the WGA-positive group (p<0.01). Univariate analysis showed WGA positivity as a significant factor associated with metachronous cancers (p<0.01), while multivariate analysis confirmed WGA positivity as an independent risk factor (p<0.01).
Interpretation
The findings suggest that WGA positivity is a significant predictor of metachronous gastric cancers, aligning with previous literature that highlights the importance of WGA in gastric cancer prognosis. However, the clinical significance of this finding should be interpreted cautiously, as the study design is retrospective and may include confounding variables. This implies that while WGA may warrant closer surveillance, further prospective studies are needed to validate these findings.
Key findings
- Metachronous gastric cancers were significantly more frequent in the WGA-positive group, p<0.01.
- Univariate analysis identified WGA positivity as significantly associated with metachronous gastric cancers, p<0.01.
- In the multivariate analysis, WGA positivity was a significant independent risk factor, p<0.01.
- A total of 160 WGA-positive and 284 WGA-negative gastric cancer cases were included.
Limitations
- Retrospective study design.
- Potential confounding factors not accounted for.
- Single institution study may limit generalizability.