Risk factors and predictive nomogram for non-curative resection in patients with early gastric cancer treated with endoscopic submucosal dissection: a retrospective cohort study.

[INTRODUCTION] The objective of this study was to determine independent clinicopathological factors that can predict submucosal invasion and non-curative resection (NCR) outcomes after endoscopic submucosal dissection (ESD) in patients with early gastric cancer (EGC).

[METHODS] Data were collected from consecutive patients who underwent gastric ESD at the First Affiliated Hospital of Ningbo University between 2016 and 2023. A retrospective analysis was conducted using the chi-squared test and logistic regression analysis. Multiple logistic regression analysis was applied to investigate factors independently predicting both submucosal invasion and NCR. These factors were used to construct predictive nomograms.

[RESULTS] A total of 511 patients (535 EGC lesions) underwent ESD. Of these, 452 were curative (84.7%), and 83 (15.5%) were non-curative. Multivariate analysis revealed that location in the body and fundus or cardia of the stomach, larger tumor size (≥ 30 mm), and histological undifferentiated type were independent risk factors for submucosal invasion and deep submucosal invasion in patients with EGC (all P < 0.05). Multivariate analysis showed that tumor size of 20 ~ 29 mm, tumor size ≥ 30 mm, elevated lesions, depressed lesions, undifferentiated tumors and submucosal invasion were all independent predictors of NCR for EGCs (all P < 0.05). The area under the ROC curve (AUC) of the nomogram model for predicting submucosal invasion and non-curative resection was 0.821 (95% CI, 0.758 ~ 0.884) and 0.937 (95%CI, 0.889 ~ 0.985), respectively.

[CONCLUSIONS] We developed nomograms to predict the risk of submucosal invasion and NCR prior to ESD. These predictive factors in addition to the existing ESD criteria can help provide the best treatment option for patients with EGC.