Comparative analysis of gastrectomy vs endoscopic therapy for T1b gastric cancer: long-term outcomes from a population-based propensity score matched cohort study

Background: Endoscopic therapy is emerging as a viable treatment for early-stage gastric cancer, but its long-term survival benefits for T1b gastric cancer remain unclear. This study aimed to investigate the efficacy of endoscopic therapy vs gastrectomy in T1bN0M0 gastric cancer. Methods: Patients with T1bN0M0 gastric cancer were identified, and demographic characteristics were compared between those undergoing endoscopic therapy and gastrectomy. Kaplan-Meier analysis and Cox regression models were used to assess clinical outcomes and prognostic factors. Propensity score matching (PSM) was used to compare overall survival (OS) and disease-specific survival (DSS) between the 2 groups, with subgroup analysis identifying the beneficiary population. Results: Among 1519 patients with T1bN0M0 gastric cancer, endoscopic therapy utilization increased notably from 3.8% in 2010 to 19.0% in 2019. Overall, 159 underwent endoscopic therapy, whereas 1360 underwent gastrectomy. Patients opting for endoscopic therapy tended to be older (61%), were White (76.1%), had lesions in the cardia/fundus region (67.9%), had lower pathologic grades (74.8%), and had tumors measuring 2 cm or less (83%). Although patients undergoing gastrectomy were associated with longer OS than those undergoing endoscopic therapy, no significant difference was observed in DSS (P =.381). After PSM, DSS remained similar between the 2 groups (P =.703), with consistent results in subgroup analysis, except for lesions located in the middle of the stomach. Conclusion: The utilization of endoscopic therapy for T1bN0M0 gastric cancer is on the rise, with comparable DSS outcomes with gastrectomy. This approach may offer a safe alternative for select high-risk surgical candidates and patients with low-risk cancers, aiming to reduce the need for unnecessary interventions. (c) 2025 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.