A Scoring System to Stratify Curability after Endoscopic Submucosal Dissection for Early Gastric Cancer: “eCura system” View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2017-04-11

AUTHORS

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 Ito, Yoshiaki Hayashi, Naoki Nakaya, Tomohiro Nakamura, Tooru Shimosegawa

ABSTRACT

OBJECTIVES: Although radical surgery is recommended for patients not meeting the curative criteria for endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) because of the potential risk of lymph node metastasis (LNM), this recommendation may be overestimated and excessive. We aimed to establish a simple scoring system for decision making after ESD. METHODS: This multicenter retrospective study consisted of two stages. First, the risk-scoring system for LNM was developed using multivariate logistic regression analysis in 1,101 patients who underwent radical surgery after having failed to meet the curative criteria for ESD of EGC. Next, the system was internally validated by survival analysis in another 905 patients who also did not meet the criteria and did not receive additional treatment after ESD. RESULTS: In the development stage, based on accordant regression coefficients, five risk factors for LNM were weighted with point values: three points for lymphatic invasion and 1 point each for tumor size >30 mm, positive vertical margin, venous invasion, and submucosal invasion ≥500 μm. Then, the patients were categorized into three LNM risk groups: low (0-1 point: 2.5% risk), intermediate (2-4 points: 6.7%), and high (5-7 points: 22.7%). In the validation stage, cancer-specific survival differed significantly among these groups (99.6, 96.0, and 90.1%, respectively, at 5 years; P<0.001). The C statistic of the system for cancer-specific mortality was 0.78. CONCLUSIONS: This scoring system predicted cancer-specific survival in patients who did not meet the curative criteria after ESD for EGC. ESD without additional treatment may be an acceptable option for patients at low risk. More... »

PAGES

874

References to SciGraph publications

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  • Journal

    TITLE

    The American Journal of Gastroenterology

    ISSUE

    6

    VOLUME

    112

    Author Affiliations

  • Department of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
  • Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
  • Division of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan
  • Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
  • Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
  • Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
  • Department of Endoscopy, Hiroshima City Hospital, Hiroshima, Japan
  • Department of Internal Medicine, Niigata Prefectural Central Hospital, Joetsu, Japan
  • Department of Gastroenterology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
  • Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan
  • Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan
  • Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan
  • Department of Gastroenterology and Endocrinology and Metabolism, Nara Medical University, Nara, Japan
  • Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
  • Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan
  • Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
  • Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
  • Department of Gastroenterology, Akita City Hospital, Akita, Japan
  • Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan
  • Division of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan
  • Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Sendai, Japan
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1038/ajg.2017.95

    DOI

    http://dx.doi.org/10.1038/ajg.2017.95

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1084776796

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/28397873


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