Application Of ECura Scoring System After Non-curative Endoscopic Sbmucosal Dissection For Early Gastric Cancer

ObjectivesTo explore the clinical value of the eCura scoring system in selecting appropriate treatment strategies after non-curative endoscopic submucosal dissection(ESD)of early gastric cancer(EGC)in an area of high incidence of gastric cancer.MethodsThe clinicopathological data of 110 patients taken after non-curative ESD for early gastric cancer were retrospectively analyzed.Patients were all treated at Fujian Provincial Hospital from January 2015 to June 2019.According to the eCura scoring system,patients were divided into three lymph node metastasis(LNM)risk groups:low-risk group(79 cases),intermediate-risk group(22 cases),and high-risk group(9cases).Based on different treatment strategies after non-curative ESD,75 patients underwent no additional treatment while 35 patients underwent standard radical surgery.The LMN and the cancer recurrence rate were compared across patients in different risk stratifications respectively.Results110 patients were divided into either the low-risk group(79 cases),intermediate-risk group(22 cases),and high-risk group(9 cases)according to the eCura scoring system.The median follow-up time was 40(12-58)months.And twenty two patients underwent additional surgery in the low-risk group,including 1(4.5%)case of lymph node metastasis.Of the 8 patients who underwent additional standard radical surgery in the intermediate-risk group,1(12.5%)case was observed with lymph node metastasis.Finally,3(60%)of the 5 patients displayed lymph node metastasis in the high-risk group.No differences were observed among the three groups in age,sex,tumor location,tumor differentiation,ulcer and horizontal margin,however,significant differences in endoscopic classification,tumor size,depth of invasion,vertical margin,lymphatic vessels invasion,and blood vessels invasion were found(P<0.05).The results of a ROC analyses showed that the cut-off value was 3 points(AUC=0.857,sensitivity=80%,specificity=90%).Logistic regression analysis showed that lymph node metastasis was statistically significant in among the three groups(P=0.034).Compared to the low-risk group,the intermediate-risk group had a slightly increased rate of LNM(OR=3,95%CI: 0.165-54.566;P=0.458),however,in the high-risk group,a significantly higher rate of LNM was detected(OR=31.5,95%CI: 2.142-463.143;P=0.012).During the follow up period,the recurrence rate of patients receiving no additional treatment and patients who underwent standard radical surgery were low in both the low-risk and intermediate-risk groups(P=0.32,P=0.296;respectively).Conversely,in the high-risk group,recurrence of patients with no additional treatment was significantly higher than in patients who underwent radical surgery(P = 0.013).ConclusionsThe eCura system could accurately predict the risk of LNM and can be applied in clinical practice.Close follow-up may be an acceptable option for patients with a low risk of LMN or intermediate-risk with scores of 2-3.On the other hand,patients with high or intermediate-risk patients with scores of 3-4 may benefit from additional surgery can be improve prognosis obviously.