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Abstract
Objective To evaluate the risk factors for lymph node metastasis (LNM) after a non-curative (NC) gastric endoscopic submucosal dissection (ESD) and to validate and eventually refine the eCura scoring system in the Western setting. Also, to assess the rate and risk factors for parietal residual disease.
Design Retrospective multicentre multinational study of prospectively collected registries from 19 Western centres. Patients who had been submitted to surgery or had at least one follow-up endoscopy were included. The eCura system was applied to assess its accuracy in the Western setting, and a modified version was created according to the results (W-eCura score). The discriminative capacities of the eCura and W-eCura scores to predict LNM were assessed and compared.
Results A total of 314 NC gastric ESDs were analysed (72% high-risk resection (HRR); 28% local-risk resection). Among HRR patients submitted to surgery, 25% had parietal disease and 15% had LNM in the surgical specimen. The risk of LNM was significantly different across the eCura groups (areas under the receiver operating characteristic curve (AUC-ROC) of 0.900 (95% CI 0.852 to 0.949)). The AUC-ROC of the W-eCura for LNM (0.916, 95% CI 0.870 to 0.961; p=0.012) was significantly higher compared with the original eCura. Positive vertical margin, lymphatic invasion and younger age were associated with a higher risk of parietal residual lesion in the surgical specimen.
Conclusion The eCura scoring system may be applied in Western countries to stratify the risk of LNM after a gastric HRR. A new score is proposed that may further decrease the number of unnecessary surgeries.
- gastric adenocarcinoma
- endoscopic procedures
- therapeutic endoscopy
- gastrointestinal endoscopy
Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Gathered data from all the participating centers are available upon reasonable request by contacting the corresponding author.
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Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Gathered data from all the participating centers are available upon reasonable request by contacting the corresponding author.
Footnotes
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RM and DL contributed equally.
Contributors RM and DL wrote the first draft of the manuscript and performed data collection and statistical analysis. MDR, MB, AL, PP-N, FB, IG, FC and GM performed interpretation of data and revised for intellectual content. AF, PB, SG, PA, RKM, PC, PB-C, RP, SS, MF, MP, FG, EA, FR-Z, HU, AW, MM, MG, AM, EGS, SX, IF-R performed data acquisition and revised for intellectual content. ERdS performed data acquisition, statistical analysis and revised for intellectual content. BS-P performed statistical analysis and revised for intellectual content. JS-A created, designed and coordinated the study, performed data collection and wrote the final manuscript, being the guarantor of the study. All authors contributed to the writing and approved the final version of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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