SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1496161
Updated Evaluation of Additional Surgery Versus Non-Gastrectomy Treatment for Early Gastric Cancer after Non-Curative Endoscopic Resection: A Meta-Analysis
Provisionally accepted
- Liaoning Cancer Hospital, China Medical University, Shenyang, China
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Introduction: Debate about whether additional surgery should be the preferred treatment option for patients with early gastric cancer who have undergone non-curative endoscopic resection is ongoing.This meta-analysis aimed to provide clarity for clinicians and patients to facilitate better-informed treatment decisions. Methods: Studies included in this meta-analysis were obtained through searches of the PubMed, Embase, and Web of Science databases. We analyzed the following prognosticrelated indicators between the groups receiving additional surgery and those receiving non-surgical treatments: 5-year overall survival, 8-year overall survival, 5-year disease-specific survival, 5-year disease-free survival, 5-year recurrence-free survival, 5-year cancer-specific survival, and clinicopathology data. Results: After applying strict inclusion and exclusion criteria, 26 studies published in English up to May 2024 were included, comprising 9,177 patients with early-stage gastric tumors following non-curative endoscopic resection. These patients were categorized into additional surgery (n=4903) and non-surgical (n=4274) groups. In our meta-analysis, the following outcomes were significantly better in the additional surgery group: 5-year overall survival (odds ratio[OR] =3.37, 95% confidence interval [CI] =2.91-3.91, p<0.00001; hazard ratio [HR] = 0.51, 95% CI=0.41-0.64, p<0.00001), 8-year overall survival (OR=1.96, 95% CI=1.22-3.16, p=0.005), 5-year disease-specific survival (OR=3.08, 95% CI=2.08-4.55, p<0.00001), 5-year disease-free survival (OR=4.17, 95% CI=1.53-11.4, p=0.005), 5-year recurrence-free survival (OR=9.14, 95% CI=3.63-23.01, p<0.00001), and 5-year cancer-specific survival (OR = 2.54, 95% CI = 1.32-4.9, p=0.005).Additionally, subgroup analysis revealed that patients over 70 years old benefitted more from surgery (OR=3.09, 95% CI=2.37-4.02, p<0.00001). The results of the analysis were significant, with minimal heterogeneity. Clinicopathological indicators were also analyzed in a detailed comparative analysis of the additional surgery and non-surgery groups. Patients in the non-surgical group were older and had more comorbidities than those in the additional surgery group. The number of patients with the following characteristics was higher in the additional surgery group: submucosal infiltration (+), SM2 invasion(+), vascular infiltration(+), lymphatic invasion(+), vertical margins(+), and lymphovascular invasion(+). Conclusions: Our review revealed that the prognostic indicators of patients in the additional surgery group were greater than those in the non-surgical treatment group, and their clinical characteristics cannot be ignored. More relevant multicenter studies are required to validate this conclusion.
Keywords: Meta-analysis, Non-curative endoscopic resection, Early Gastric Cancer, Additional surgery, Prognostic outcomes, clinicopathologic features 560
Received: 13 Sep 2024; Accepted: 30 Jun 2025.
Copyright: © 2025 Wang, Zhu, Gao, Zhao, Xiang and Zhu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jia Zhu, Liaoning Cancer Hospital, China Medical University, Shenyang, China
Na Gao, Liaoning Cancer Hospital, China Medical University, Shenyang, China
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