Waku Hatta1, Takuji Gotoda2, Tsuneo Oyama3, Noboru Kawata4, Akiko Takahashi3, Yoshikazu Yoshifuku5, Shu Hoteya6, Masahiro Nakagawa7, Masaaki Hirano8, Mitsuru Esaki9, Mitsuru Matsuda10, Ken Ohnita11, Kohei Yamanouchi12, Motoyuki Yoshida13, Osamu Dohi14, Jun Takada15, Keiko Tanaka16, Shinya Yamada17, Tsuyotoshi Tsuji18, Hirotaka Ito19, Yoshiaki Hayashi20, Tomohiro Nakamura21, Naoki Nakaya21, Tooru Shimosegawa1. 1. Department of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. 2. Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan. takujigotoda@yahoo.co.jp. 3. Division of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan. 4. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan. 5. Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. 6. Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan. 7. Department of Endoscopy, Hiroshima City Hospital, Hiroshima, Japan. 8. Department of Internal Medicine, Niigata Prefectural Central Hospital, Joetsu, Japan. 9. Department of Gastroenterology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan. 10. Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan. 11. Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan. 12. Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan. 13. Department of Gastroenterology and Endocrinology and Metabolism, Nara Medical University, Nara, Japan. 14. Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 15. Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan. 16. Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan. 17. Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan. 18. Department of Gastroenterology, Akita City Hospital, Akita, Japan. 19. Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan. 20. Division of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan. 21. Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Sendai, Japan.
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.
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.
Entities:
Keywords:
Early gastric cancer; Endoscopic submucosal dissection; eCura system
Authors: Ji Eun Na; Hyuk Lee; Yang Won Min; Byung-Hoon Min; Jun Haeng Lee; Poong-Lyul Rhee; Kyoung-Mee Kim; Jae J Kim Journal: J Cancer Res Clin Oncol Date: 2021-03-05 Impact factor: 4.553
Authors: Chan Hyuk Park; Dong-Hoon Yang; Jong Wook Kim; Jie-Hyun Kim; Ji Hyun Kim; Yang Won Min; Si Hyung Lee; Jung Ho Bae; Hyunsoo Chung; Kee Don Choi; Jun Chul Park; Hyuk Lee; Min-Seob Kwak; Bun Kim; Hyun Jung Lee; Hye Seung Lee; Miyoung Choi; Dong-Ah Park; Jong Yeul Lee; Jeong-Sik Byeon; Chan Guk Park; Joo Young Cho; Soo Teik Lee; Hoon Jai Chun Journal: Intest Res Date: 2020-10-13