bluuebunny/crossref_metadata_2025_split huggingface dataset:
A phase I/II study of nivolumab, paclitaxel, and ramucirumab as second-line in advanced gastric cancer.
Authors: Hironaka Shuichi , Kadowaki Shigenori , Izawa Naoki , Nishina Tomohiro , Yamanaka Takeharu , Minashi Keiko , Muro Kei , Sunakawa Yu , Kajiwara Takeshi , Hayashi Yuichiro , Kawakami Yutaka , Nakajima Takako Eguchi 
Published: February 2020

352 Background: Synergistic anti-tumor effect induced by simultaneous blockade of PD-1 and taxanes, and PD-1 and VEGFR-2 has been reported. A phase I/II study was conducted to investigate the safety and efficacy of nivolumab (Nivo) with paclitaxel (PTX) plus ramucirumab (Ram), which is the standard treatment as the second-line treatment for advanced gastric cancer (AGC). Methods: AGC patients (pts) with measurable lesions, ECOG PS 0-1, and disease progression on the first-line chemotherapy with fluoropyrimidine and platinum were eligible. Pts received Nivo (3 mg/kg on days 1 and 15) combined with PTX (80 mg/m2 on days 1, 8 and 15) and Ram (8 mg/kg on days 1 and 15) (Level 1), every 4 weeks. After feasibility was evaluated in 6 pts (phase I part), additional 37 pts were enrolled in a phase II part with the primary endpoint of 6-month progression-free survival (PFS) rate. The combined positive score (CPS) is defined as the number of PD-L1 positive cells (tumor cells, macrophages, and lymphocytes) divided by the total number of viable tumor cells. Results: Fourty-three AGC pts were enrolled: median age, 66 years; ECOG PS 1, 48.8%; and CPS ≥1, 60.5%. Dose limiting toxicities were observed in 2 pts in the phase I part and recommended dose was determined as Level 1. ORR was 37.2% (95%CI, 23.0-53.5%): 46.2% (95%CI, 26.6-66.6%) in CPS≥1 pts and 30.8% (95%CI, 9.1-61.4%) in CPS < 1 pts. With a median follow-up time of 16.8 months, 6-month PFS rate was 46.4% (80% CI, 36.4-55.8%) ( P= 0.067): 57.7% (95%CI, 36.8-73.9%) in CPS≥1 pts and 38.5% (95%CI, 14.1-62.9%) in CPS < 1 pts. Median PFS was 5.1 months (95%CI, 4.5-6.5 months). Median survival time was 13.1 months (95%CI, 8.0-16.6 months): 13.8 months (95%CI, 8.0-19.5 months) in CPS≥1 pts and 8.0 months (95%CI, 4.8-24.1 months) in CPS < 1 pts, and 18-months survival rate was 32.1% (95%CI, 18.2-46.8%). Conclusions: Nivo with PTX plus Ram demonstrated promising antitumor activity as the 2nd-line treatment for AGC pts with manageable toxicities. Clinical trial information: UMIN000025947.
Low-grade gastric mucosa-associated lymphoid tissue lymphoma: Clinicopathological factors associated with Helicobacter pylori eradication and tumor regression.
Authors: Shim Hyun Ik , Lee Dong Ho , Cho Jae Ho , Shin Cheol Min , Yoon Hyuk , Park Young Soo , Kim Nayoung 
Published: February 2020

353 Background: Eradication of Helicobacter pylori is widely accepted as the initial therapy for low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma. The aim of this study was to assess the remission and relapse rates of low-grade gastric MALT lymphoma after H. pylori eradication and to identify the clinical factors affecting remission. Methods: We retrospectively analyzed 151 patients diagnosed with gastric MALT lymphoma from May 2003 to December 2018. Results: Of the 151 patients, 112 (74.2%) had an H. pylori infection. Total regression rates with eradication was 90.2% (101/112) in H. pylori-positive patients and 55% (11/20) in H. pylori-negative patients. Age, sex, tumor location, endoscopic findings, and the severity of mononuclear lymphocytes were not related to achieving successful initial H. pylori eradication and remission. However, patients with a smaller H. pylori burden ( p=0.030) and less neutrophil infiltration ( p=0.003) were more likely to achieve a successful initial H. pylori eradication. H. pylori ( p<0.001) and the burden ( p=0.020) were significantly related to remission of MALT lymphoma. Conclusions: The results show that H. pylori burden and neutrophil infiltration were inversely related to the success of the initial H. pylori eradication procedure and that the H. pylori burden was inversely related to the remission of MALT lymphoma.
DKN-01 in combination with pembrolizumab in patients with advanced gastroesophageal adenocarcinoma (GEA): Tumoral DKK1 expression as a predictor of response and survival.
Authors: Klempner Samuel J. , Bendell Johanna C. , Villaflor Victoria Meucci , Tenner Laura LaNiel , Stein Stacey , Naik Girish S. , Sirard Cynthia A. , Kagey Michael , Chaney Marya F. , Strickler John H. 
Published: February 2020

357 Background: Dickkopf-1 (DKK1) modulates Wnt signaling and contributes to an immune suppressive tumor microenvironment. DKN-01 (D), a neutralizing DKK1 antibody + pembrolizumab (P) has demonstrated safety and clinical activity in advanced GEA. We report response and survival outcomes in anti-PD-1/anti-PD-L1 naïve GEA patients by high/low tumoral DKK1 expression. Methods: We enrolled advanced anti-PD-1/PD-L1 naïve GEA patients (pts) in a Phase 1b/2a study of D + P (NCT02013154). Tumoral DKK1 mRNA expression was assessed by an in situ hybridization RNAscope assay. Objective response rate (ORR), disease control rate (DCR), progression free survival (PFS) and overall survival (OS) were compared between DKK1 high and low groups. Kaplan-Meier method and Cox-PH model was used for survival analysis and logistic regression was used for clinical benefit/response outcome. Results: 34 GEA pts were enrolled to receive 300 mg D + P. 31 GEA pts had DKK1 expression available (25 response-evaluable/RE) and 27 had both DKK1 and PD-L1 expression available (22 RE). In RE pts, DKK1 high (H-score ≥ upper-tertile [≥35]) had an ORR of 50% (5 PR/10), DCR of 80% (8/10) while DKK1 low ( < upper-tertile) had an ORR of 0% (0/15) and DCR of 20% (3/15); DKK1 high (vs. low) had an OR of 16 (95%CI: 2.2, 118.3; n = 25) and adjusted (for PD-L1 CPS ≥10 vs. < 10) OR of 17.6 (95%CI:1.6, 194.4; n = 22) for clinical benefit/response (PR/SD vs. PD). Median PFS was 22.1 weeks in DKK1 high (n = 11) vs. 5.9 weeks in DKK1 low (n = 20); HR of 0.23 (95%CI: 0.082, 0.66; n = 31). Adjusted (for PD-L1 expression) HR for DKK1 high was 0.20 (95%CI: 0.061,0.68; n = 27) for PFS. DKK1 high (n = 11) had a median OS of 31.6 weeks vs. 17.4 weeks in DKK1 low (n = 20); HR of 0.45 (95%CI: 0.16, 1.3; n = 31) and adjusted HR of 0.62 (95%CI: 0.2,1.9; n = 27). Conclusions: High levels of tumoral DKK1 expression identify advanced anti-PD-1/PD-L1 naïve GEA pts with the greatest benefit from D + P. Improvements in response/clinical benefit and PFS were observed independent of PD-L1 expression. Tumoral DKK1 as a potential predictive biomarker for DKN-01 treated GEA pts will be evaluated in future studies. Overall survival follow-up is ongoing. Clinical trial information: NCT02013154.
Postoperative adjuvant chemotherapy with S-1 versus SOX/XELOX regimens for pStage III gastric cancer: A cohort study.
Authors: Tsuchiya Nobuhiro , Kunisaki Chikara 
Published: February 2020

358 Background: Adjuvant chemotherapy following curative gastrectomy is recommended for patients with pStage II or III, except pT3 (ss), N0 gastric cancer in Japan. This study aimed to compare the efficacy of postoperative adjuvant chemotherapy with S-1 versus SOX/XELOX for pStageIII gastric cancer. Methods: Between January 2015 and December 2018, 51 patients with pStage III gastric cancer underwent curative gastrectomy. The combination therapy group received a combined SOX and XELOX regimen as follows: (1) SOX regimen: 130 mg/m2 of oxaliplatin on day 1 every 3 weeks combined with 40 mg/m2 of S-1 twice daily on days 1–14 every 3 weeks; (2) XELOX regimen: 130 mg/m2 of oxaliplatin on day 1 every 3 weeks combined with 1000 mg/m2 of capecitabine twice daily on days 1–14 every 3 weeks. We evaluated their hospital records retrospectively. The indication of SOX/XELOX regimens was based on PS and intent of patients. Results: The S-1 group comprised 28 cases (pStage III A/B/C: 12/8/8), while the SOX/XELOX group comprised 23 cases (pStage III A/B/C: 4/10/9). There was no difference in age, sex, comorbidity, prognostic nutritional index and stage between two groups. The 2-year DFS of the S-1 group and the SOX/XELOX group were 58.6% and 71.7%, respectively (p = 0.367). Subgroup analysis showed that the 2-year DFS of patients with pStage IIIC gastric cancer in the S-1 group was significantly lower than the SOX/XELOX group (S-1 vs. SOX/XELOX: 25.9% vs. 78.7%, p = 0.041). As concerns adverse effects (CTCAE ver 4.0), peripheral sensory neuropathy was significantly higher in the SOX/XELOX group than in the S-1 group (S-1: grade I/II 3.6%/0% vs. SOX/XELOX: grade I/II 21.7%/34.8%, p < 0.001), although the other adverse effects did not differ between the two groups. Conclusions: SOX/XELOX therapy may be more useful than S-1 therapy for more advanced tumors among pStage III gastric cancers.
Is splenectomy for dissecting splenic hilar lymph nodes justified in scirrhous type of gastric cancer?
Authors: Hayashi Tsutomu , Yoshikawa Takaki , Kamiya Ayako , Date Keichi , Wada Takeyuki , Otsuki Sho , Yamagata Yukinori , Katai Hitoshi , Nishida Toshirou 
Published: February 2020

359 Background: Splenectomy for dissecting splenic hilar nodes (#10) should be avoided for most gastric cancer considering high morbidity and no survival benefit, while that is often selected in scirrhous type of gastric cancer because this special type frequently invades the whole stomach and the #10 nodes. Splenectomy is necessary for dissecting #10, however, survival benefit of dissecting #10 is unclear. Methods: Patients who had scirrhous gastric cancer and underwent D2 total gastrectomy with splenectomy in National Cancer Center Hospital, Japan, between 2000 to 2011 were retrospectively analyzed. The therapeutic value index was calculated by multiplying the metastatic rate of each nodal station and the 5-year survival of patients who had metastasis to each node. Results: In total, 144 patients were eligible for the present study. The most frequent metastatic site was the nodes along the lessar curvature (#3, 57%), followed by the nodes along the right gastro-epiploic artery (#4d, 45%), the right nodes located at the cardia (#1, 34%), the nodes along the left gastro-epiploic artery (#4sb, 23%), the inferior nodes at the pyloric ring (#6, 22%), the nodes along the left gastric artery (#7, 21%), the nodes along the short gastric artery (#4sa, 18%), the nodes along the cardiac branched artery (#2, 15%), the nodes around the spleen (#10, 15%), the distal nodes along the splenic artery (#11d, 15%), the proximal nodes along the splenic artery (#11p, 13%), the nodes around the celiac artery (#9, 13%), and the nodes along the common hepatic artery (#8a, 10%). These lymph nodes had a metastatic rate of more than 10%. The node with the highest index was #3(18), followed by #4d(13.4), #1(9.59), #4sa(5.85), #4sb(5.75), #10(4.86), #7(4.16), #11d(4.16), #11p(3.87), #2(3.07), #8a(2.08), and #9(1.39). The index of #10 was exceeded that of #2, #7, #8a, and #9 which are the key nodes dissected in D2. Conclusions: The metastatic rate of splenic hilar nodes was relatively high, and the therapeutic index was the sixth highest in the fifteen regional lymph nodes included in D2 dissection. Splenectomy for dissecting splenic hilar nodes would be justified in scirrhous type of gastric cancer considering its survival benefit.
Safety and tolerability of oxaliplatin based pressurized intraperitoneal aerosol chemotherapy (PIPAC) for patients with peritoneal carcinomatosis: A phase I dose-finding study in Asian patients.
Authors: Sundar Raghav , Kim Guo Wei , Tan Hon Lyn , Wang Lingzhi , Chue Koy Min , Tai Chia Hui , Teo Siok Chin , Jang Clarisse , Chee Corissa , Lieske Bettina , Chee Cheng Ean , Shabbir Asim , So Jimmy Bok Yan , Yong Wei-Peng 
Published: February 2020

360 Background: PIPAC is a novel, laparoscopic intraperitoneal chemotherapy delivery technique which aims to improve on hyperthermic intraperitoneal chemotherapy (HIPEC), ameliorating drug distribution and tissue penetration. Thus far, PIPAC has been conducted with oxaliplatin chemotherapy in Europe, at an arbitrary dose of 92mg/m2; 150mg/m2 was found to be intolerable. We conducted a dose-escalation phase 1 study to establish the safety, tolerability and recommended phase 2 dose (RP2D) for PIPAC in Asian patients. Methods: This phase 1 study of oxaliplatin administered via PIPAC was designed as a traditional 3+3 dose escalation study for patients with predominant peritoneal metastasis from a gastrointestinal primary tumor, after failure of standard therapies. Dose levels were planned at 45, 60, 90 and 120mg/m2. Repeat doses of PIPAC were permitted, 6 weeks apart. Dose limiting toxicities (DLT) were defined as any clinically relevant grade 3 adverse events occurring within 28 days after PIPAC. Results: This study included 16 patients (25 PIPAC procedures; 8 gastric, 4 colorectal and 1 gallbladder, pancreas and appendix cancer each). Median age was 62 years, with a median peritoneal carcinomatosis index (PCI) score of 17 (range 1 - 39). Two patients developed pancreatitis (grade 2 and 3) on day 6 and day 9 after PIPAC administration at the dose cohort of 45mg/m2, necessitating cohort expansion to 6 patients. One patient was noted to have asymptomatic grade 3 hyperamylasemia (90mg/m2 cohort). There were no other DLTs and all 3 patients in the highest dose cohort (120mg/m2) tolerated PIPAC well. Nine patients who underwent a 2nd PIPAC procedure had a decrease in PCI score from 18.4 to 15.5; one patient at 120mg/m2 had an improvement in PCI from 30 to 12. Conclusions: The RP2D of PIPAC with oxaliplatin is 120mg/m2. Single agent PIPAC is well tolerated, and future studies with PIPAC must consider a bi-directional approach with the incorporation of systemic therapy, with either chemotherapy or immunotherapy to improve efficacy. Clinical trial information: NCT03172416.
Enhanced efficacy of anti-VEGFR2/taxane therapy after progression on immune checkpoint inhibition (ICI) in patients (pts) with metastatic gastroesophageal adenocarcinoma (mGEA).
Authors: Kankeu Fonkoua Lionel Aurelien , Chakrabarti Sakti , Sonbol Mohamad Bassam , Kasi Pashtoon Murtaza , Starr Jason Scott , Liu Alex J , Bois Melanie C. , Pitot Henry C. , Ross Helen J. , Wu Tsung-Teh , Graham Rondell P. , Markovic Svetomir , Dong Haidong , Yoon Harry H. 
Published: February 2020

362 Background: Most pts with mGEA do not respond to ICI or ramucirumab/paclitaxel (RAM/TAX). Emerging data suggest that ICI may potentiate subsequent therapy (Tx). In KN059 we unexpectedly observed durable responses in 2 pts on RAM/TAX after ICI (PMID 29674442). We examined if ICI impacts efficacy of subsequent RAM/TAX in a larger cohort and explored alterations in the tumor microenvironment. Methods: All pts with mGEA at Mayo Clinic (MN, AZ, FL) who received RAM/TAX (2014-19) were included. We compared best objective response rate (ORR: complete [CR] or partial response [PR]) per RECIST1.1 and overall survival (OS) in pts who received RAM/TAX with (Group A) vs without (Group B) immediately preceding PD-1 blockade. Chi square and multivariate logistic and Cox regression were used. We adjusted for total lines of Tx received and the line of Tx in which RAM/TAX was given, to control for potential differences in the biology of heavily treated pts or those receiving RAM/TAX as 2nd vs 3rd line Tx. We also adjusted for age and ECOG PS. Results: In total 87 pts met inclusion criteria. In the 19 pts (Group A) who received RAM/TAX (usually as 3rd line Tx) after progression on ICI, there was a 77% relative risk reduction of death after initiation of RAM/TAX compared to the 68 pts (Group B) who received RAM/TAX (usually as 2nd line) without preceding ICI (median OS 15.0 vs 7.6 mo; HR 0.23; P < .001). The ORR was also significantly higher (58% vs 18%; P < .001) including the CR rate (16% vs 1%; P = .006). Two CRs in Group A are ongoing (10 - 34 mo). Of note, 95% of Group A pts did not respond to ICI, and all had irRECIST progression on ICI. Immunofluorescent analysis from a responder showed 65-fold reduction (post vs pre-Tx) in intratumoral density of immunosuppressive FOXP3+ Tregs, with preserved density of antitumor CD8+ T cells. Conclusions: Higher than expected efficacy was observed on RAM/TAX when immediately preceded by ICI, suggesting ICI may enhance efficacy of subsequent anti-VEGFR/taxane therapy. This serial immunotherapy combination may be a novel option for pts with primary resistance to ICI and will be tested prospectively in a new randomized phase 2 trial (NCT04069273).
Refusal of surgery results in inferior survival in esophageal cancer.
Authors: Parsons Matthew , Tao Randa , Lloyd Shane , Johnson Skyler Bryce , Scaife Courtney L. , Garrido-Laguna Ignacio , Varghese Thomas 
Published: February 2020

364 Background: Trimodality therapy with chemoradiation followed by surgery is the standard of care for non-metastatic esophageal cancer. Some patients refuse surgery and this information is captured in the National Cancer Database (NCDB). We sought to understand factors associated with refusal of surgery in these patients and to compare their survival rates with those who undergo surgery. Methods: Data from the NCDB for patients with pathologically proven non-metastatic esophageal cancer from 2006 to 2013 were pooled and screened. Patients with T1N0M0 disease were excluded. Pearson’s chi-squared test and multivariate logistic regression analyses were used to assess the distribution of demographic, clinical, and treatment factors. After propensity-score matching with inverse probability of treatment weighting, overall survival (OS) was compared between patients who refused surgery and those who had surgery using Kaplan Meier analyses and doubly-robust estimation with multivariate Cox proportional hazards modeling. Results: We found 890 of 18,942 patients (4.6%) refused surgery. Older patients, females, those with squamous histology, patients insured by Medicare and those who received radiation therapy (RT) were more likely to refuse. Patients who had N1 disease, high incomes, those who received chemotherapy and those who lived farther from care were more likely to have surgery. The initial 6 month OS was not significantly different between patients who refused surgery and those who had surgery (93.5% vs 95.1% P= 0.064). However, five-year OS was significantly lower in patients who refused (16.4% vs. 38.4% P< .01). This survival decrement was observed uniquely in patients with both adenocarcinoma and squamous cell carcinoma histology. Among those who refused surgery, the OS decrement was mitigated by increasing RT doses. In those who received over 54 Gy of RT, there was no statistical difference in OS between the groups (HR = 0.84, 95% CI 0.65-1.09). Conclusions: We identified a number of patient characteristics that are related to the refusal of surgery in esophageal cancer. Refusal of surgery was related to a decrease in OS in propensity weighted cohorts. This survival decrement may be mitigated by RT in a dose dependent fashion.
A phase II study of nab-paclitaxel plus ramucirumab for the second-line treatment of patients with metastatic gastroesophageal cancer.
Authors: Bendell Johanna C. , Percent Ivor John , Weaver Robert Waide , Chua Cynthia Coo , Xiong Henry Q. , Cohn Allen Lee , Zakari Ahmed , Singh Jaswinder , Kozloff Mark , Lietman Caressa , Lane Cassie Michelle , Jones Suzanne Fields , Finney Lindsey H. , Carmody Sean , Womack Mark Sanders 
Published: February 2020

365 Background: Nab-paclitaxel (NP) is a protein-stabilized formulation of paclitaxel, US FDA approved for treatment of metastatic breast cancer, advanced/metastatic non-small cell lung cancer and metastatic adenocarcinoma of the pancreas. Ramucirumab (R) is an antibody targeting vascular epithelial growth factor receptor 2 (VEGFR-2) approved for treatment of gastric or gastroesophageal (GE) adenocarcinoma in combination with paclitaxel as 2nd line treatment. This phase II study evaluated the efficacy of NP and R for pts with metastatic GE cancer. Methods: Pts with metastatic GE adenocarcinoma were treated with 125 mg/m2 NP on days 1, 8, and 15, and 8 mg/kg R on days 1 and 15 of each 28-day cycle. Pts continued study treatment (tx) until intolerable toxicity, disease progression (PD), or withdrawal of consent. Restaging occurred every 2 cycles. The primary objective was progression-free survival (PFS); secondary objectives were response rate (RR), time to progression (TTP), overall survival (OS) and toxicity. Results: 65 pts were enrolled between 05/15 and 12/18: median age 63 yrs (35-86), 75% male, 71% ECOG 1. Primary tumor sites were stomach (37%), GE junction (35%), and esophagus (28%). 83% were stage IV at initial diagnosis. 29% were HER2+ at study entry. 57% had 1st line chemo, 40% chemo + targeted agent and 3% chemo + immunotherapy. Median tx duration was 13 weeks (.1-55) for NP and 12 weeks (.1-54) for R; at data cutoff 2 pts remained on tx.60% discontinued due to PD; 17% due to AE. 43% and 23% had AE-related dose reductions of NP and R, respectively; 8% and 6% were on day 15. 58% had dose interruptions of R due to AE; 42% on day 15. Median PFS was 3.8 months (CI 95% 3.4, 4.8); median TTP 4.5 months (CI 95% 3.5, 6.3); and median OS 8.8 months (CI 95% 6.1, 11.3). RR was 15% (CI 95% 6.6, 24.2); disease control rate was 68% (CI 95% 56.3, 79.1). Most common tx related AEs were neutropenia (55%), fatigue (40%), peripheral neuropathy (37%), anorexia and mucositis (26% each). Conclusions: There were no unexpected toxicity findings with NP and R in pts with GE cancers. Compared to historical controls, outcomes in this study were similar to those seen in the Western population of pts who received paclitaxel plus R. Clinical trial information: NCT02317991.
Endoscopic versus surgical resection for mucosal esophageal squamous cell carcinoma: Treatment outcomes and factors affecting survival.
Authors: Kim Ga Hee , Song Ho June , Na Hee Kyong , Ahn Ji Yong , Lee Jeong Hoon , Jung Kee Wook , Kim Do Hoon , Choi Kee Don , Lee Gin Hyug , Jung Hwoon-Yong 
Published: February 2020

368 Background: Mucosal esophageal squamous cell carcinoma (T1a EC) is treated with endoscopic (ER) or surgical resection (SR). The data regarding prognosis of T1a EC and the associated factors are still lacking. This study aimed to compare the treatment outcomes of T1a EC in ER and SR groups, and to investigate the factors affecting long-term survival. Methods: We retrieved data for 263 patients with T1a EC who underwent ER (n = 200) or SR (n = 63). Relevant clinical and tumor-specific parameters were reviewed. Underlying comorbidity was scored using Charlson co-morbidity index (CCI). Significant factors affecting survival were determined by Cox regression analysis. Results: The mean age of the patients was 64.5±8.0 years. During a mean follow-up of 54.4±20.4 months, the 5-year overall survival (OS) of all T1a EC patients was 85.7% (86.8% in ER and 82.4% in SR group; p = 0.631). In multivariate analysis, CCI was a significant factor affecting survival (p < 0.001). The 5-year OS was 60.2% in patients with CCI > 2 and 88.2% in patients with CCI ≤2 (p < 0.001). The 5-year cumulative incidence of primary EC recurrence was 1.9% and metachronous EC recurrence was 15.1% in ER group (0% in SR group). Incidence of subsequent second primary cancers was 9% in ER and 9.5% in SR. The 5-year cumulative incidences of all cases of cancer recurrence in ER and SR groups were 27.5% and 10.8%, respectively (p = 0.037). The procedure-related adverse events occurred in 10.0% in ER and 41.3% in SR (p < 0.001). Among the 24 (12.0%) and 10 (15.9%) deaths in ER and SR group, respectively, primary EC-specific death was not reported. The major causes of death were second primary cancers in ER group (75%), and post-operative complications or organ failure in SR group (70%). Conclusions: Long-term survival was excellent in patients undergoing ER or SR for T1a EC. The prognosis of T1a EC was significantly associated with underlying comorbidity. Attention should be paid to metachronous cancer recurrence in ER group and operation-related adverse events in SR group.