Is the eCura system useful for selecting patients who require radical surgery after noncurative endoscopic submucosal dissection for early gastric cancer? A comparative study

Waku Hatta, Takuji Gotoda, Tsuneo Oyama, Noboru Kawata, Akiko Takahashi, Yoshikazu Yoshifuku, Shu Hoteya, Masahiro Nakagawa, Masaaki Hirano, Mitsuru Esaki, Mitsuru Matsuda, Ken Ohnita, Kohei Yamanouchi, Motoyuki Yoshida, Osamu Dohi, Jun Takada, Keiko Tanaka, Shinya Yamada, Tsuyotoshi Tsuji, Hirotaka ItoYoshiaki Hayashi, Tomohiro Nakamura, Naoki Nakaya, Tooru Shimosegawa

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: We have established a risk-scoring system, termed the “eCura system,” for the risk stratification of lymph node metastasis in patients who have received noncurative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). We aimed to clarify whether this system contributes to the selection of patients requiring radical surgery after ESD. Methods: Between 2000 and 2011, 1,969 patients with noncurative ESD for EGC were included in this multicenter study. Depending on the treatment strategy after ESD, we had patients with no additional treatment (n = 905) and those with radical surgery after ESD (n = 1,064). After the application of the eCura system to these patients, cancer recurrence and cancer-specific mortality in each risk category of the system were compared between the two patient groups. Results: Multivariate Cox analysis revealed that in the high-risk category, cancer recurrence was significantly higher (hazard ratio = 3.13, p = 0.024) and cancer-specific mortality tended to be higher (hazard ratio = 2.66, p = 0.063) in patients with no additional treatment than in those with radical surgery after ESD, whereas no significant differences were observed in the intermediate-risk and low-risk categories. In addition, cancer-specific survival in the low-risk category was high in both patient groups (99.6 and 99.7%). A limitation of this study is that it included a small number of cases with undifferentiated-type EGC (292 cases). Conclusions: The eCura system is a useful aid for selecting the appropriate treatment strategy after noncurative ESD for EGC. However, caution is needed when applying this system to patients with undifferentiated-type EGC.

Original languageEnglish
Pages (from-to)481-489
Number of pages9
JournalGastric Cancer
Volume21
Issue number3
DOIs
Publication statusPublished - 2018 May 1

Keywords

  • Early gastric cancer
  • Endoscopic submucosal dissection
  • eCura system

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research

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    Hatta, W., Gotoda, T., Oyama, T., Kawata, N., Takahashi, A., Yoshifuku, Y., Hoteya, S., Nakagawa, M., Hirano, M., Esaki, M., Matsuda, M., Ohnita, K., Yamanouchi, K., Yoshida, M., Dohi, O., Takada, J., Tanaka, K., Yamada, S., Tsuji, T., ... Shimosegawa, T. (2018). Is the eCura system useful for selecting patients who require radical surgery after noncurative endoscopic submucosal dissection for early gastric cancer? A comparative study. Gastric Cancer, 21(3), 481-489. https://doi.org/10.1007/s10120-017-0769-7