{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:46:04Z","timestamp":1791931564863,"version":"4.3.4"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Gastric Cancer"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Additional gastrectomy is recommended after noncurative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) despite the low incidence of lymph node metastasis (LNM). The eCura system, W-eCura score, and 11-point score reportedly predict LNM risk; however, their comparative performance remains unclear. We aimed to externally validate and directly compare five risk stratification approaches in patients with noncurative ESD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively evaluated 634 consecutive patients with EGC who underwent noncurative ESD at a single high-volume center. Five prediction models were evaluated: the eCura system (7-point score and three-risk classification), W-eCura score (7-point score and three-risk classification), and 11-point score. All pathological findings were re-evaluated by an outcome-blinded expert pathologist. Model performance was assessed by discrimination, calibration, and decision-curve analysis (DCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>LNM was identified in 26 (4.9%) patients. All models showed comparable discrimination (c-statistics, 0.71 to 0.72). However, calibration-in-the-large and calibration slope were poorer in the W-eCura score and 11-point score (\u2212\u20091.43 to \u2212\u20090.96 and 0.26 to 0.64) than in the eCura system (\u2212\u20090.43 to \u2212\u20090.40 and 0.83 to 0.84). Using DCA, the eCura system and W-eCura score consistently showed higher net benefits than did the 11-point score across clinically relevant threshold probabilities. Recalibration improved both calibration and net benefits across all models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite similar discriminative performance, the eCura system demonstrated relatively favorable calibration and potential clinical utility in this Japanese cohort. Given their simplicity and structural similarity, three-risk classifications of the eCura system and W-eCura score, when appropriately calibrated, may support decision-making regarding additional gastrectomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10120-026-01798-9","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T10:00:15Z","timestamp":1788775215000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["External validation and comparison of five prediction models for lymph node metastasis after noncurative endoscopic submucosal dissection for early gastric cancer"],"prefix":"10.1007","author":[{"given":"Ayaka","family":"Takasu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9717-0281","authenticated-orcid":false,"given":"Waku","family":"Hatta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuji","family":"Gotoda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Ogata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichiro","family":"Kemmoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroto","family":"Noda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Souya","family":"Nunobe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"Santos-Antunes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Kawachi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"1798_CR1","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1136\/gut.48.2.225","volume":"48","author":"H Ono","year":"2001","unstructured":"Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut. 2001;48:225\u20139.","journal-title":"Gut"},{"key":"1798_CR2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10120-006-0408-1","volume":"10","author":"T Gotoda","year":"2007","unstructured":"Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer. 2007;10:1\u201311.","journal-title":"Gastric Cancer"},{"key":"1798_CR3","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1055\/a-1811-7025","volume":"54","author":"P Pimentel-Nunes","year":"2022","unstructured":"Pimentel-Nunes P, Lib\u00e2nio D, Bastiaansen BAJ, Bhandari P, Bisschops R, Bourke MJ, et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) guideline\u2014update 2022. Endoscopy. 2022;54:591\u2013622.","journal-title":"Endoscopy"},{"issue":"29","key":"1798_CR4","first-page":"271","volume":"2026","author":"Japanese gastric cancer treatment guidelines","year":"2025","unstructured":"Japanese gastric cancer treatment guidelines. 7th edition. Gastric Cancer. 2025;2026(29):271\u201399.","journal-title":"Gastric Cancer"},{"key":"1798_CR5","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1007\/s10120-016-0651-z","volume":"20","author":"H Suzuki","year":"2017","unstructured":"Suzuki H, Oda I, Abe S, Sekiguchi M, Nonaka S, Yoshinaga S, et al. Clinical outcomes of early gastric cancer patients after noncurative endoscopic submucosal dissection in a large consecutive patient series. 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The other authors declare no conflicts of interest.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}