Gut Liver.
2023 Jul;17(4):537-546. 10.5009/gnl220333.
External Validation of the eCura System for Undifferentiated-Type Early Gastric Cancer with Noncurative Endoscopic Resection
- Yang HJ
1 - Kim YI2
- Ahn JY3
- Choi KD3
- Kim SG4
- Jeon SW5
- Kim JH6
- Shin SK7
- Lee H8
- Lee WS9
- Kim GH10
- Park JM11
- Shin WG12
- Choi IJ2
- Affiliations
-
- 1Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- 2Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
- 3Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 4Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
- 5Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
- 6Department of Internal Medicine, Institute of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- 7Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- 8Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- 9Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- 10Department of Internal Medicine, Pusan National University College of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- 11Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- 12Department of Internal Medicine, Institute for Liver and Digestive Diseases, Hallym University College of Medicine, Chuncheon, Korea
- KMID: 2544896
- DOI: http://doi.org/10.5009/gnl220333
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-tohigh 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.
- Full Text Links
-
- Actions
-
Cited
- CITED
-
- Close
- Share
-
- Similar articles
-
- Endoscopic Resection of Undifferentiated Early Gastric Cancer
- The Clinical Significance and Management of Noncurative Endoscopic Resection in Early Gastric Cancer
- Endoscopic Resection of Undifferentiated-type Early Gastric Cancer
- Corrigendum to: External Validation of the eCura System for Undifferentiated-Type Early Gastric Cancer with Noncurative Endoscopic Resection
- Strategy for Curative Endoscopic Resection of Undifferentiated-Type Early Gastric Cancer
