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

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 undifferentiat...

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Published in:Gut and liver 2023-07, Vol.17 (4), p.537
Main Authors: Hyo-joon Yang, Young-il Kim, Ji Yong Ahn, Kee Don Choi, Sang Gyun Kim, Seong Woo Jeon, Jie-hyun Kim, Sung Kwan Shin, Hyuk Lee, Wan Sik Lee, Gwang Ha Kim, Jae Myung Park, Woon Geon Shin, Il Ju Choi
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Language:Korean
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Endoscopic mucosal resection
Lymphatic metastasis
Stomach neoplasms
Undifferentiated-type histology
Validation study
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container_issue 4
container_start_page 537
container_title Gut and liver
container_volume 17
creator Hyo-joon Yang
Young-il Kim
Ji Yong Ahn
Kee Don Choi
Sang Gyun Kim
Seong Woo Jeon
Jie-hyun Kim
Sung Kwan Shin
Hyuk Lee
Wan Sik Lee
Gwang Ha Kim
Jae Myung Park
Woon Geon Shin
Il Ju Choi
description 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
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fullrecord <record><control><sourceid>kiss</sourceid><recordid>TN_cdi_kiss_primary_4034735</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><kiss_id>4034735</kiss_id><sourcerecordid>4034735</sourcerecordid><originalsourceid>FETCH-kiss_primary_40347353</originalsourceid><addsrcrecordid>eNp9jcFOwlAQRd8CE0H9AjfzA01KC1TWTZEVCwW3ZPI6L4yW95qZQW3Cx1sT167O4p7cM3HT-bpaZUXxVN66mep7nq_mRbWcumvzbSQRO3jDjls0ThFSADsRUH0RhNdBjc4QksAhthwCCUVjNGqz_dATNCjdAM-oJuyhxuhJ4IvtBLsU_Xhh_DlasU3qUz8qL6Tkf0P37iZgp_Twxzv3uGn29Tb7YNVjL3xGGY6LvFxU5bL8f_0Bb6RJVQ</addsrcrecordid><sourcetype>Publisher</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>External Validation of the eCura System for Undifferentiated-Type Early Gastric Cancer with Noncurative Endoscopic Resection</title><source>Open Access: PubMed Central</source><creator>Hyo-joon Yang ; Young-il Kim ; Ji Yong Ahn ; Kee Don Choi ; Sang Gyun Kim ; Seong Woo Jeon ; Jie-hyun Kim ; Sung Kwan Shin ; Hyuk Lee ; Wan Sik Lee ; Gwang Ha Kim ; Jae Myung Park ; Woon Geon Shin ; Il Ju Choi</creator><creatorcontrib>Hyo-joon Yang ; Young-il Kim ; Ji Yong Ahn ; Kee Don Choi ; Sang Gyun Kim ; Seong Woo Jeon ; Jie-hyun Kim ; Sung Kwan Shin ; Hyuk Lee ; Wan Sik Lee ; Gwang Ha Kim ; Jae Myung Park ; Woon Geon Shin ; Il Ju Choi</creatorcontrib><description>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&lt;0.001) and cancer-specific survival rates (99.7%, 94.7%, and 80.0% at 5 years, respectively, p&lt;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. (Gut Liver 2023;17:537-546)</description><identifier>ISSN: 1976-2283</identifier><language>kor</language><publisher>대한소화기내시경학회</publisher><subject>Endoscopic mucosal resection ; Lymphatic metastasis ; Stomach neoplasms ; Undifferentiated-type histology ; Validation study</subject><ispartof>Gut and liver, 2023-07, Vol.17 (4), p.537</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784</link.rule.ids></links><search><creatorcontrib>Hyo-joon Yang</creatorcontrib><creatorcontrib>Young-il Kim</creatorcontrib><creatorcontrib>Ji Yong Ahn</creatorcontrib><creatorcontrib>Kee Don Choi</creatorcontrib><creatorcontrib>Sang Gyun Kim</creatorcontrib><creatorcontrib>Seong Woo Jeon</creatorcontrib><creatorcontrib>Jie-hyun Kim</creatorcontrib><creatorcontrib>Sung Kwan Shin</creatorcontrib><creatorcontrib>Hyuk Lee</creatorcontrib><creatorcontrib>Wan Sik Lee</creatorcontrib><creatorcontrib>Gwang Ha Kim</creatorcontrib><creatorcontrib>Jae Myung Park</creatorcontrib><creatorcontrib>Woon Geon Shin</creatorcontrib><creatorcontrib>Il Ju Choi</creatorcontrib><title>External Validation of the eCura System for Undifferentiated-Type Early Gastric Cancer with Noncurative Endoscopic Resection</title><title>Gut and liver</title><addtitle>Gut and Liver</addtitle><description>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&lt;0.001) and cancer-specific survival rates (99.7%, 94.7%, and 80.0% at 5 years, respectively, p&lt;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. 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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. (Gut Liver 2023;17:537-546)</abstract><pub>대한소화기내시경학회</pub><tpages>10</tpages></addata></record>
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subjects Endoscopic mucosal resection
Lymphatic metastasis
Stomach neoplasms
Undifferentiated-type histology
Validation study
title External Validation of the eCura System for Undifferentiated-Type Early Gastric Cancer with Noncurative Endoscopic Resection
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