Determination of Additional Surgery after Non-Curative Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Practically Modified Application of the eCura System

Background: Additional surgery after non-curative endoscopic submucosal dissection (ESD) may be excessive as few patients have lymph node metastasis (LNM). It is necessary to develop a risk stratification system for LNM after non-curative ESD, such as the eCura system, which was introduced in the Ja...

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Autores principales:	Sejin Lee, Jeong Ho Song, Sung Hyun Park, Minah Cho, Yoo Min Kim, Hyoung-Il Kim, Woo Jin Hyung
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	non-curative ESD lymph node metastasis eCura system Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/d62fd0ba0edd4b09a153d458682cab54
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spelling	oai:doaj.org-article:d62fd0ba0edd4b09a153d458682cab542021-11-25T17:03:46ZDetermination of Additional Surgery after Non-Curative Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Practically Modified Application of the eCura System10.3390/cancers132257682072-6694https://doaj.org/article/d62fd0ba0edd4b09a153d458682cab542021-11-01T00:00:00Zhttps://www.mdpi.com/2072-6694/13/22/5768https://doaj.org/toc/2072-6694Background: Additional surgery after non-curative endoscopic submucosal dissection (ESD) may be excessive as few patients have lymph node metastasis (LNM). It is necessary to develop a risk stratification system for LNM after non-curative ESD, such as the eCura system, which was introduced in the Japanese gastric cancer treatment guidelines. However, the eCura system requires venous and lymphatic invasion to be separately assessed, which is difficult to distinguish without special immunostaining. In this study, we practically modified the eCura system by classifying lymphatic and venous invasion as lymphovascular invasion (LVI). Method: We retrospectively reviewed 543 gastric cancer patients who underwent radical gastrectomy after non-curative ESD between 2006 and 2019. LNM was evaluated according to LVI as well as size >30 mm, submucosal invasion ≥500 µm, and vertical margin involvement, which were used in the eCura system. Results: LNM was present in 8.1% of patients; 3.6%, 2.3%, 7.4%, 18.3%, and 61.5% of patients with no, one, two, three, and four risk factors had LNM, respectively. The LNM rate in the patients with no risk factors (3.6%) was not significantly different from that in patients with one risk factor (2.3%, <i>p</i> = 0.523). Among patients with two risk factors, the LNM rate without LVI was significantly lower than with LVI (2.4% vs. 10.7%, <i>p</i> = 0.027). Among patients with three risk factors, the LNM rate without LVI was lower than with LVI (0% vs. 20.8%, <i>p</i> = 0.195), although not statistically significantly. Based on LNM rates according to risk factors, patients with LVI and other factors were assigned to the high-risk group (LNM, 17.4%) while other patients as a low-risk group (LNM, 2.4%). Conclusions: Modifying the eCura system by classifying lymphatic and venous invasion as LVI successfully stratified LNM risk after non-curative ESD. Moreover, the high-risk group can be simply identified based on LVI and the presence of other risk factors.Sejin LeeJeong Ho SongSung Hyun ParkMinah ChoYoo Min KimHyoung-Il KimWoo Jin HyungMDPI AGarticlenon-curative ESDlymph node metastasiseCura systemNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancers, Vol 13, Iss 5768, p 5768 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	non-curative ESD lymph node metastasis eCura system Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	non-curative ESD lymph node metastasis eCura system Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Sejin Lee Jeong Ho Song Sung Hyun Park Minah Cho Yoo Min Kim Hyoung-Il Kim Woo Jin Hyung Determination of Additional Surgery after Non-Curative Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Practically Modified Application of the eCura System
description	Background: Additional surgery after non-curative endoscopic submucosal dissection (ESD) may be excessive as few patients have lymph node metastasis (LNM). It is necessary to develop a risk stratification system for LNM after non-curative ESD, such as the eCura system, which was introduced in the Japanese gastric cancer treatment guidelines. However, the eCura system requires venous and lymphatic invasion to be separately assessed, which is difficult to distinguish without special immunostaining. In this study, we practically modified the eCura system by classifying lymphatic and venous invasion as lymphovascular invasion (LVI). Method: We retrospectively reviewed 543 gastric cancer patients who underwent radical gastrectomy after non-curative ESD between 2006 and 2019. LNM was evaluated according to LVI as well as size >30 mm, submucosal invasion ≥500 µm, and vertical margin involvement, which were used in the eCura system. Results: LNM was present in 8.1% of patients; 3.6%, 2.3%, 7.4%, 18.3%, and 61.5% of patients with no, one, two, three, and four risk factors had LNM, respectively. The LNM rate in the patients with no risk factors (3.6%) was not significantly different from that in patients with one risk factor (2.3%, <i>p</i> = 0.523). Among patients with two risk factors, the LNM rate without LVI was significantly lower than with LVI (2.4% vs. 10.7%, <i>p</i> = 0.027). Among patients with three risk factors, the LNM rate without LVI was lower than with LVI (0% vs. 20.8%, <i>p</i> = 0.195), although not statistically significantly. Based on LNM rates according to risk factors, patients with LVI and other factors were assigned to the high-risk group (LNM, 17.4%) while other patients as a low-risk group (LNM, 2.4%). Conclusions: Modifying the eCura system by classifying lymphatic and venous invasion as LVI successfully stratified LNM risk after non-curative ESD. Moreover, the high-risk group can be simply identified based on LVI and the presence of other risk factors.
format	article
author	Sejin Lee Jeong Ho Song Sung Hyun Park Minah Cho Yoo Min Kim Hyoung-Il Kim Woo Jin Hyung
author_facet	Sejin Lee Jeong Ho Song Sung Hyun Park Minah Cho Yoo Min Kim Hyoung-Il Kim Woo Jin Hyung
author_sort	Sejin Lee
title	Determination of Additional Surgery after Non-Curative Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Practically Modified Application of the eCura System
title_short	Determination of Additional Surgery after Non-Curative Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Practically Modified Application of the eCura System
title_full	Determination of Additional Surgery after Non-Curative Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Practically Modified Application of the eCura System
title_fullStr	Determination of Additional Surgery after Non-Curative Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Practically Modified Application of the eCura System
title_full_unstemmed	Determination of Additional Surgery after Non-Curative Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Practically Modified Application of the eCura System
title_sort	determination of additional surgery after non-curative endoscopic submucosal dissection in patients with early gastric cancer: a practically modified application of the ecura system
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/d62fd0ba0edd4b09a153d458682cab54
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Determination of Additional Surgery after Non-Curative Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Practically Modified Application of the eCura System

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