External validation of the eCura system and comparison with the W-eCura score for predicting lymph node metastasis after non-curative endoscopic submucosal dissection for early gastric cancer: a multicenter retrospective cohort study.
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引用次数: 0
Abstract
Background: The eCura system is a widely used risk-scoring model for predicting lymph node metastasis (LNM) after non-curative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), but its external validation is limited. Recently, the W-eCura score, a modified version, was proposed. We aimed to validate the eCura system and compare its discriminatory performance with the W-eCura score.
Methods: A multicenter retrospective study was conducted using data from 19 Japanese institutions. The patients who underwent ESD for EGC followed by gastrectomy with lymph node dissection were included. The predictive performance of the eCura system, including calibration and discrimination, was evaluated and its discrimination was compared with the W-eCura score.
Results: Among 901 eligible patients, 65 cases (7.2%) showed LNM. The eCura system demonstrated good calibration, with a calibration-in-the-large of -0.008 (95% confidence interval [CI] -0.024-0.010), an observed-to-expected ratio of 0.905 (95% CI 0.707-1.121), and a calibration slope of 0.975 (95% CI 0.692-1.257). Discrimination was also good, with a C-statistic of 0.741 (95% CI 0.676-0.806). In patients evaluable for both systems, the C-statistics for the eCura system and W-eCura score were 0.745 (95% CI 0.675-0.816) and 0.750 (95% CI 0.684-0.817), respectively, showing no significant difference (P = 0.547).
Conclusions: The eCura system was validated as a reliable tool for predicting LNM following ESD in real-world clinical settings.
背景：eCura系统是一种广泛使用的风险评分模型，用于预测早期胃癌（EGC）非治愈性内镜粘膜下剥离（ESD）术后淋巴结转移（LNM），但其外部验证有限。最近，W-eCura评分，一个修改版本，被提出。我们旨在验证eCura系统，并将其歧视性表现与W-eCura评分进行比较。方法：采用日本19家机构的资料进行多中心回顾性研究。我们的研究对象是接受ESD治疗的EGC患者，随后进行胃切除术并淋巴结清扫。评估了eCura系统的预测性能，包括校准和判别，并将其判别与W-eCura评分进行了比较。结果：901例符合条件的患者中，65例（7.2%）出现LNM。eCura系统显示出良好的校准效果，校准大值为-0.008(95%置信区间[CI] -0.024-0.010)，观察期望比为0.905 (95% CI 0.707-1.121)，校准斜率为0.975 （95% CI 0.692-1.257）。鉴别性也很好，c统计量为0.741 （95% CI 0.676-0.806）。在两种系统均可评估的患者中，eCura系统的c统计量和W-eCura评分分别为0.745 （95% CI 0.675-0.816）和0.750 (95% CI 0.684-0.817)，差异无统计学意义（P = 0.547）。结论：在现实世界的临床环境中，eCura系统被证实是预测ESD后LNM的可靠工具。
期刊介绍：
The Journal of Gastroenterology, which is the official publication of the Japanese Society of Gastroenterology, publishes Original Articles (Alimentary Tract/Liver, Pancreas, and Biliary Tract), Review Articles, Letters to the Editors and other articles on all aspects of the field of gastroenterology. Significant contributions relating to basic research, theory, and practice are welcomed. These publications are designed to disseminate knowledge in this field to a worldwide audience, and accordingly, its editorial board has an international membership.
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