Safety Assessment And Predictive Factors Of Non-curative Endoscopic Submucosal Dissection For Early Gastric Cancer

Objective: To collect the clinical related data of early gastric cancer(EGC)patients who underwent endoscopic submucosal dissection(ESD)in southern Anhui.For the noncurative resection group,use the eCura scoring system to grade the risk and evaluate the clinical applicability of the system in southern Anhui,and explore the risk factors of poor prognosis such as the occurrence of non-curative resection,lymph node metastasis and recurrence.To provide data reference for clinicians to evaluate the preoperative risk and choose the postoperative treatment strategy.Methods: The early gastric cancer patients who underwent endoscopic submucosal dissection in our digestive endoscopy center from January 2016 to April 2022 were selected for retrospective analysis,and their endoscopic,clinicopathological and other characteristics were analyzed.The risk of non-curative resection cases was stratified based on the eCura scoring system,and were divided into low,medium and high risk groups according to the scoring results.The application value of the system was evaluated by the area under curve(AUC)of receiver operating characteristic(ROC)curve,the lymph node metastasis and recurrence rates of each risk group were compared,and the predictive efficacy of eCura was explored.The prognosis of residual recurrence and lymph node metastasis in each group was observed through postoperative follow-up,and the difference between the two groups was compared.Single factor analysis was used to calculate the risk factors related to non-curative resection of ESD,and multiple factor analysis was used to screen independent risk factors.Furthermore,logistic regression analysis was used to explore the impact of risk stratification of eCura scoring system on lymph node metastasis and tumor recurrence of patients.Kaplan Meier method and Log rank test were used.Results: The early gastric cancer patients who underwent endoscopic submucosal dissection in our digestive endoscopy center from January 2016 to April 2022 were selected for retrospective analysis,and their endoscopic,clinicopathological and other characteristics were analyzed.The risk of non curative resection cases was stratified according to the eCura scoring system,and they were divided into low,medium and high risk groups according to the scoring results,The application value of the system was evaluated by the area under curve(AUC)of receiver operating characteristic(ROC)curve,the lymph node metastasis and recurrence rates of each risk group were compared,and the predictive efficacy of eCura was explored.The prognosis of residual recurrence and lymph node metastasis in each group was observed through postoperative follow-up,and the difference between the two groups was compared.Single factor analysis was used to analyze the risk factors related to non curative resection of ESD,and multiple factor analysis was used to screen independent risk factors.Logistic regression analysis was used to explore the impact of risk stratification of eCura scoring system on lymph node metastasis and tumor recurrence of patients.The recurrence rate was compared by Kaplan Meier method and Log rank test.Conclusion: Endoscopic submucosal dissection is a relatively safe and effective treatment method.For patients with lesions larger than 2cm,infiltration depth reaching submucosa,ulcers and pathological indications of poor differentiation,we should be alert to the occurrence of non curative resection.The eCura scoring system shows good predictive efficacy in predicting lymph node metastasis,and we need to focus on the prognosis of medium and high-risk groups.