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

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

doi:10.1007/s10120-017-0769-7

Cited by 55 publications

(57 citation statements)

References 26 publications

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“…Recently, we performed a large-scale multicenter retrospective study of patients who did not meet the curative criteria for endoscopic submucosal dissection (ESD) of EGC [14-18]. In this study, we established and validated a 7-point risk-scoring system with 3 risk classifications (0–1 points, low-risk; 2–4 points, intermediate risk; 5–7 points, high-risk), named the eCura system, for evaluating the risk of LNM, which consists of 5 pathological factors: lymphatic invasion, a tumor size >30 mm, positive vertical margin, deep submucosal invasion, and vascular invasion [15, 18].…”

Section: Introductionmentioning

confidence: 99%

“…In this study, we established and validated a 7-point risk-scoring system with 3 risk classifications (0–1 points, low-risk; 2–4 points, intermediate risk; 5–7 points, high-risk), named the eCura system, for evaluating the risk of LNM, which consists of 5 pathological factors: lymphatic invasion, a tumor size >30 mm, positive vertical margin, deep submucosal invasion, and vascular invasion [15, 18]. In this system, smaller, deep submucosal invasive EGC in which complete resection of ER is achieved without lymphvascular invasion is 1 point and regarded as a low-risk for LNM (2.5% risk), and follow-up with no additional treatment after ER is reported to be an acceptable option [15, 18]. However, in this system, some factors, such as an undifferentiated component in submucosal invasion and the details of SID, were not evaluated.…”

Section: Introductionmentioning

confidence: 99%

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The Role of an Undifferentiated Component in Submucosal Invasion and Submucosal Invasion Depth After Endoscopic Submucosal Dissection for Early Gastric Cancer

Miyahara¹,

Hatta

Nakagawa³

et al. 2018

Digestion

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Background/Aims: The role of an undifferentiated component in submucosal invasion and submucosal invasion depth (SID) for lymph node metastasis (LNM) of early gastric cancer (EGC) with deep submucosal invasion (SID ≥500 μm from the muscularis mucosa) after endoscopic submucosal dissection (ESD) has not been fully understood. This study aimed to clarify the risk factors (RFs), including these factors, for LNM in such patients. Methods: We enrolled 513 patients who underwent radical surgery after ESD for EGC with deep submucosal invasion. We evaluated RFs for LNM, including an undifferentiated component in submucosal invasion and the SID, which was subdivided into 500–999, 1,000–1,499, 1,500–1,999, and ≥2,000 µm. Results: LNM was detected in 7.6% of patients. Multivariate analysis revealed that an undifferentiated component in submucosal invasion (OR 2.22), in addition to tumor size >30 mm (OR 2.51) and lymphatic invasion (OR 3.07), were the independent RFs for LNM. However, the SID was not significantly associated with LNM. Conclusion: An undifferentiated component in submucosal invasion was one of the RFs for LNM, in contrast to SID, in patients who underwent ESD for EGC with deep submucosal invasion. This insight would be helpful in managing such patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Role of an Undifferentiated Component in Submucosal Invasion and Submucosal Invasion Depth After Endoscopic Submucosal Dissection for Early Gastric Cancer

Miyahara¹,

Hatta

Nakagawa³

et al. 2018

Digestion

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“…When no additional treatment is selected in such patients, there is no recommendation on the intervals of follow up in the guidelines (Fig. ), although a report proposed scheduled surveillance with intervals of not more than 6 months by CT scan . However, it should be noted that it is difficult to make a long‐term prognosis in most cases when metastatic recurrence is found in patients with no additional treatment after ESD with eCura C‐2 …”

Section: Management After Er In Each Curability Categorymentioning

confidence: 99%

History and future perspectives in Japanese guidelines for endoscopic resection of early gastric cancer

Hatta

Gotoda

Koike

et al. 2019

Digestive Endoscopy

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Japanese guidelines for gastric cancer treatment were first published in 2001 for the purpose of showing the appropriate indication for each treatment method, thereby reducing differences in the therapeutic approach among institutions, and so on. With the accumulation of evidence and the development and prevalence of endoscopic submucosal dissection (ESD), the criteria for the indication and curability of endoscopic resection (ER) for early gastric cancer (EGC) have expanded. However, several problems still remain. Although a risk-scoring system (eCura system) for predicting lymph node metastasis (LNM) may help treatment decision in patients who do not meet the curative criteria for ER of EGC, which is referred to as eCura C-2 in the latest guidelines, additional gastrectomy with lymphadenectomy may be excessive for many patients, even those at high risk for LNM. Less-invasive function-preserving surgery, such as non-exposed endoscopic wall-inversion surgery with laparoscopic sentinel node sampling, may overcome this problem. In addition, further less-invasive treatment, such as ER with chemotherapy, should be established for patients who prefer not to undergo additional gastrectomy. CONCEPT AND UPDATE OF THE JAPANESE GUIDELINESJ APANESE GASTRIC CANCER Association (JGCA) guidelines were first published in 2001 9 for the purpose of: (i) showing the appropriate indication of each treatment method for gastric cancer; (ii) reducing differences in the therapeutic approach among institutions; (iii) improving the safety and outcome of treatment for gastric cancer; (iv) reducing the personnel and economic burden by avoiding unnecessary treatment; and (v) improving mutual understanding between medical staff and patients. With the accumulation of evidence, the guidelines were updated in

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“…The LNM rate was 2.5%, 6.7%, and 22.7% for low, intermediate and high‐risk groups, respectively, in the training cohort, and the 5‐year CSS of each group was 99.6%, 96.0%, and 90.1%, respectively, in the validation stage. The researchers further explored 1969 cases in 19 institutions to discern whether the system could help select patients needed radical surgery . After applying the eCura system to these patients, cancer recurrence and CSS for each risk category were compared between patients who underwent additional treatment after ESD and those who did not.…”

Section: Surveillance Strategy For Egcmentioning

confidence: 99%

“…In another single‐center retrospective study in Japan, a LNM scoring model with a total score of 11 points was established . Unlike the eCura system, the ulcers or scars and histopathological type, but not the vertical margin, were identified as risk factors for LNM, suggesting that caution is needed for EGC with ulceration or scar formation, poorly differentiated adenocarcinoma, and mixed type of differentiation …”

Section: Surveillance Strategy For Egcmentioning

confidence: 99%

Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review

Zhang

Gao

et al. 2019

J of Digest Diseases

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With the wide application of endoscopic resection for early gastric cancer (EGC) by not only Asian endoscopists but also those from Western countries, reviews on standardized treatment processes before and after endoscopic resection are nevertheless lacking. In this article we provide a narrative review of studies on the selection of appropriate EGC for endoscopic resection and the follow-up strategies for those with histologically confirmed EGC after endoscopic resection. EGC should be comprehensively assessed before endoscopic resection, including its exact margin, invasive depth and risk of lymph node metastasis (LNM). While the curative resection status of EGC may be evaluated after endoscopic resection based on the newly developed eCura system, although this needs to be further verified. Surveillance with endoscopy and computed tomography scan is necessary for patients with an EGC level A or B. An additional endoscopic resection is recommended for patients with a level-C1 EGC. For patients with a level-C2 EGC, close follow-up is suggested for low-risk tumors of level C2 and additional surgery for those at high risks. Further postoperative strategy is suggested based on comprehensive assessment of the risk of LNM, patient's quality of life and wishes. K E Y W O R D Scurative resection, early gastric cancer, eCura system, endoscopy, gastric neoplasms, surveillance

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

Abstract: 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.

Cited by 55 publications

References 26 publications

The Role of an Undifferentiated Component in Submucosal Invasion and Submucosal Invasion Depth After Endoscopic Submucosal Dissection for Early Gastric Cancer

The Role of an Undifferentiated Component in Submucosal Invasion and Submucosal Invasion Depth After Endoscopic Submucosal Dissection for Early Gastric Cancer

History and future perspectives in Japanese guidelines for endoscopic resection of early gastric cancer

Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review

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