Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Surg Endosc. 2023 Oct;37(10):7738-7748. doi: 10.1007/s00464-023-10324-2. Epub 2023 Aug 11.
Radical surgery after non-curative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) may be excessive, since only 5-10% of patients have lymph node metastasis (LNM). This study investigated the suitability of the eCura system for determining the need for radical surgery after non-curative ESD.
We retrospectively investigated 343 patients who underwent non-curative ESD for EGC from 2006 to 2021 at a tertiary hospital in Korea. These patients were divided into surgery (n = 191) and observation (n = 152) groups based on whether they underwent additional surgery post-ESD. Each group was further classified into low-risk (eCura score 0-1), intermediate-risk (eCura score 2-4) and high-risk (eCura score 5-7). All patients were regularly followed-up at least annually after the initial treatment. The cumulative overall and recurrence-free survival rates were calculated for each category and compared between the surgery and observation groups.
No significant differences in overall survival were found between the surgery and observation groups in low-risk (p = 0.168) and intermediate-risk patients (p = 0.306); however, high-risk patients had better 5-year overall survival rate in the surgery group than in the follow-up group (95.2% vs. 71.4%, p < 0.001). The 5-year recurrence-free survival rate was higher in the surgery group than in the observation group for low-risk (100% vs. 84.3%; p = 0.034), intermediate-risk (96.1% vs. 88.4%; p = 0.081) and high-risk patients (100% vs. 83.3%; p = 0.023).
Follow-up without additional surgery after non-curative ESD can be a reasonable option for low-risk and even intermediate-risk patients according to the eCura system. However, surgery is warranted for eCura high-risk patients.
对于早期胃癌（EGC），非治愈性内镜黏膜下剥离术（ESD）后的根治性手术可能是过度的，因为只有 5-10%的患者发生淋巴结转移（LNM）。本研究旨在探讨 eCura 系统在判断非治愈性 ESD 后是否需要根治性手术方面的适用性。
我们回顾性调查了 2006 年至 2021 年在韩国一家三级医院接受非治愈性 ESD 治疗的 343 例 EGC 患者。这些患者根据 ESD 后是否接受额外手术分为手术组（n=191）和观察组（n=152）。每组进一步分为低危组（eCura 评分 0-1）、中危组（eCura 评分 2-4）和高危组（eCura 评分 5-7）。所有患者在初始治疗后至少每年进行定期随访。计算了每个类别的累积总生存率和无复发生存率，并比较了手术组和观察组之间的差异。
在低危组（p=0.168）和中危组患者中（p=0.306），手术组和观察组之间的总生存率无显著差异；然而，高危组患者的手术组 5 年总生存率高于观察组（95.2% vs. 71.4%，p<0.001）。对于低危（100% vs. 84.3%；p=0.034）、中危（96.1% vs. 88.4%；p=0.081）和高危患者（100% vs. 83.3%；p=0.023），手术组的无复发生存率高于观察组。
根据 eCura 系统，非治愈性 ESD 后不进行额外手术的随访可以作为低危甚至中危患者的合理选择。然而，对于 eCura 高危患者，手术是必要的。
