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Multicenter Study
. 2023 Jul 15;17(4):537-546.
doi: 10.5009/gnl220333. Epub 2023 May 10.

External Validation of the eCura System for Undifferentiated-Type Early Gastric Cancer with Noncurative Endoscopic Resection

Hyo-Joon Yang  1 , Young-Il Kim  2 , Ji Yong Ahn  3 , Kee Don Choi  3 , Sang Gyun Kim  4 , Seong Woo Jeon  5 , Jie-Hyun Kim  6 , Sung Kwan Shin  7 , Hyuk Lee  8 , Wan Sik Lee  9 , Gwang Ha Kim  10 , Jae Myung Park  11 , Woon Geon Shin  12 , Il Ju Choi  2
Affiliations
Multicenter Study

External Validation of the eCura System for Undifferentiated-Type Early Gastric Cancer with Noncurative Endoscopic Resection

Hyo-Joon Yang et al. Gut Liver. .

Abstract

Background/aims: The eCura system, a scoring model for stratifying the lymph node metastasis risk after noncurative endoscopic resection for early gastric cancer (EGC), has been internally validated, primarily for differentiated-type EGC. We aimed to externally validate this model for undifferentiated-type EGC.

Methods: This multicenter, retrospective cohort study included 634 patients who underwent additional surgery (radical surgery group, n=270) or were followed up without additional treatment (no additional treatment group, n=364) after noncurative endoscopic resection for undifferentiated-type EGC between 2005 and 2015. The lymph node metastasis and survival rates were compared according to the risk categories.

Results: For the radical surgery group, the lymph node metastasis rates were 2.6%, 10.9%, and 14.8% for the low-, intermediate-, and high-risk eCura categories, respectively (p for trend=0.003). For the low-, intermediate-, and high-risk categories in the no additional treatment group, the overall survival (92.7%, 68.9%, and 80.0% at 5 years, respectively, p<0.001) and cancer-specific survival rates (99.7%, 94.7%, and 80.0% at 5 years, respectively, p<0.001) differed significantly. In the multivariate analysis, the hazard ratios (95% confidence interval) in the no additional treatment group relative to the radical surgery group were 3.18 (1.41 to 7.17; p=0.005) for overall mortality and 2.60 (0.46 to 14.66; p=0.280) for cancer-specific mortality in the intermediate-to-high risk category. No such differences were noted in the low-risk category.

Conclusions: The eCura system can be applied to undifferentiated-type EGC. Close follow-up without additional treatment might be considered for low-risk patients, while additional surgery is recommended for intermediate- and high-risk patients.

Keywords: Endoscopic mucosal resection; Lymphatic metastasis; Stomach neoplasms; Undifferentiated-type histology; Validation study.

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Conflict of interest statement

CONFLICTS OF INTEREST

J.H.K. and G.H.K. are editorial board members of the journal but were not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflicts of interest relevant to this article were reported.

Figures

Fig. 1
Fig. 1
The flowchart of the study cohort.
Fig. 2
Fig. 2
Overall survival according to the risk categories of the eCura system. (A) No additional treatment group. (B) Radical surgery group.
Fig. 3
Fig. 3
Cancer-specific survival according to the risk categories of the eCura system. (A) No additional treatment group. (B) Radical surgery group.
See this image and copyright information in PMC

Comment in

References

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