Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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A Modified eCura System to Stratify the Risk of Lymph Node Metastasis in Undifferentiated-Type Early Gastric Cancer After Endoscopic Resection

  • Hyo-Joon Yang (Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Hyuk Lee (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Tae Jun Kim (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Da Hyun Jung (Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine) ;
  • Kee Don Choi (Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ji Yong Ahn (Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Wan Sik Lee (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Seong Woo Jeon (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Jie-Hyun Kim (Department of Internal Medicine, Institute of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Gwang Ha Kim (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Jae Myung Park (Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Sang Gyun Kim (Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Woon Geon Shin (Department of Internal Medicine, Institute for Liver and Digestive Diseases, Hallym University College of Medicine) ;
  • Young-Il Kim (Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center) ;
  • Il Ju Choi (Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center)
  • Received : 2023.10.07
  • Accepted : 2023.12.07
  • Published : 2024.04.01
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Abstract

Purpose: The original eCura system was designed to stratify the risk of lymph node metastasis (LNM) after endoscopic resection (ER) in patients with early gastric cancer (EGC). We assessed the effectiveness of a modified eCura system for reflecting the characteristics of undifferentiated-type (UD)-EGC. Materials and Methods: Six hundred thirty-four patients who underwent non-curative ER for UD-EGC and received either additional surgery (radical surgery group; n=270) or no further treatment (no additional treatment group; n=364) from 18 institutions between 2005 and 2015 were retrospectively included in this study. The eCuraU system assigned 1 point each for tumors >20 mm in size, ulceration, positive vertical margin, and submucosal invasion <500 ㎛; 2 points for submucosal invasion ≥500 ㎛; and 3 points for lymphovascular invasion. Results: LNM rates in the radical surgery group were 1.1%, 5.4%, and 13.3% for the low-(0-1 point), intermediate- (2-3 points), and high-risk (4-8 points), respectively (P-fortrend<0.001). The eCuraU system showed a significantly higher probability of identifying patients with LNM as high-risk than the eCura system (66.7% vs. 22.2%; McNemar P<0.001). In the no additional treatment group, overall survival (93.4%, 87.2%, and 67.6% at 5 years) and cancer-specific survival (99.6%, 98.9%, and 92.9% at 5 years) differed significantly among the low-, intermediate-, and high-risk categories, respectively (both P<0.001). In the high-risk category, surgery outperformed no treatment in terms of overall mortality (hazard ratio, 3.26; P=0.015). Conclusions: The eCuraU system stratified the risk of LNM in patients with UD-EGC after ER. It is strongly recommended that high-risk patients undergo additional surgery.

Keywords

Acknowledgement

This research was supported by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (Grant No. HC20C0123).

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