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

• Published in: Gut and liver Vol. 17; no. 4; pp. 537 - 546
• 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
• Format: Journal Article
• Language: Korean
• Published: 대한소화기학회 30-07-2023
• Subjects: Endoscopic mucosal resection; Lymphatic metastasis; Stomach neoplasms; Undifferentiated-type histology; Validation study
• ISSN: 1976-2283

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. (Gut Liver 2023;17:537-546)