The eCura system as a novel indicator for the necessity of salvage surgery after non-curative ESD for gastric cancer: A case-control study

Endoscopic submucosal dissection (ESD) for early gastric cancer does not always lead to complete cancer resection. The aim of this study was to determine indicators for cancer residue (CR) status in cases of non-curative ESD. We analyzed 47 cases of non-curative ESD followed by salvage surgery and c...

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Bibliographic Details
Published in:PloS one 2018-10, Vol.13 (10), p.e0204039-e0204039
Main Authors: Niwa, Hirotaka, Ozawa, Rie, Kurahashi, Yasunori, Kumamoto, Tsutomu, Nakanishi, Yasutaka, Okumura, Koichi, Matsuda, Ikuo, Ishida, Yoshinori, Hirota, Seiichi, Shinohara, Hisashi
Format: Article
Language:English
Subjects:
Biology and Life Sciences
Cancer
Care and treatment
Comparative analysis
Dissection
Endoscopy
Gastric cancer
Lymph nodes
Lymphatic system
Mathematical analysis
Medical prognosis
Medicine
Medicine and Health Sciences
Metastases
Metastasis
Methods
Pathology
Patient outcomes
Patients
Physiological aspects
Risk analysis
Risk factors
Risk groups
Salvage
Stomach cancer
Surgery
Surgical outcomes
Tumor removal
Tumors
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Summary:Endoscopic submucosal dissection (ESD) for early gastric cancer does not always lead to complete cancer resection. The aim of this study was to determine indicators for cancer residue (CR) status in cases of non-curative ESD. We analyzed 47 cases of non-curative ESD followed by salvage surgery and collected data regarding the rates of CR, which included both local CR and lymph node metastasis (LNM). To elucidate the risk factors for CR status, we compared the CR positive and the CR negative groups among surgical specimens according to the following variables obtained from ESD findings: tumor location, tumor size, depth of invasion, lympho-vascular invasion, histological margin, and histological diagnosis. The eCura system, which is an LNM risk scoring system, was also applied and scores were calculated in each case as follows: 3 points for lymphatic invasion and 1 point each for tumor size >30 mm, positive vertical margin, venous invasion, and submucosal invasion ≥500 μm. There were 9 (19%) CR positive cases, which included 6 cases of local CR and 4 cases of LNM; no cancer was detected in over 80% of the patients. The eCura scoring system was the only significant factor for CR status: the higher the eCura score, the greater the CR positivity (p = 0.0128). In particular, all patients in the low-risk group (score = 0-1 point) had no CR. Although no cancer recurrence was observed during a median follow-up of 4 years, 2 patients died of pneumonia. In conclusion, the eCura system might make it possible to select appropriate cases for salvage surgery.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0204039