{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T21:35:21Z","timestamp":1788816921520,"version":"build-2803163510"},"reference-count":23,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100020829","name":"Japanese Gastric Cancer Association","doi-asserted-by":"publisher","award":["JGCA\u201036"],"award-info":[{"award-number":["JGCA\u201036"]}],"id":[{"id":"10.13039\/100020829","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Endoscopic submucosal dissection (ESD) is currently the standard treatment for early gastric cancer (EGC) without risk of lymph node metastasis (LNM). However, it is unclear whether the \u201ceCura system,\u201d can be applied to undifferentiated\u2010type EGC after non\u2010curative resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This nationwide, multicenter, retrospective study included consecutive patients that resulted in non\u2010curative resection for undifferentiated\u2010type EGC between January 2011 and March 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 1049 patients were divided into the additional surgery (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009716) and the follow\u2010up without additional surgery (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009333) groups. LNM occurred in 6% of the additional surgery group. Tumor size &gt;\u200930\u2009mm and lymphatic invasion were independent risk factors for LNM upon multivariate logistic regression analyses. The area under the receiver operating characteristic curve (AUC) for the exploratory scoring system (incorporating these risk factors) for LNM prediction was 0.768 (95% confidence interval [CI]: 0.687\u20130.848) and that for the eCura system was 0.783 (0.703\u20130.864;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.464). The eCura system was used to stratify the follow\u2010up without additional surgery group according to risk. Five\u2010year cancer\u2010specific survival differed among the low\u2010, intermediate\u2010, and high\u2010risk groups (99.6%, 96.9%, and 60.6%, respectively;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The hazard ratios for cancer recurrence in the intermediate\u2010 and high\u2010risk groups were 6.54 (95% CI: 0.41\u2013104.20) and 98.2 (12.10\u2013798.50), respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Lymphatic invasion and a tumor size &gt;\u200930\u2009mm are associated with the risk of LNM. Our findings support using the eCura system for risk stratification in undifferentiated\u2010type EGC after non\u2010curative resection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/den.70148","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T03:50:06Z","timestamp":1775793006000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk Factors for Metastasis and Prognosis in Non\u2010Curative Resection After Endoscopic Submucosal Dissection for Undifferentiated\u2010Type Early Gastric Cancer in a Nationwide Cohort in Japan"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5350-8970","authenticated-orcid":false,"given":"Kazuo","family":"Shiotsuki","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Kanagawa Cancer Center  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7702-0427","authenticated-orcid":false,"given":"Kohei","family":"Takizawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kanagawa Cancer Center  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akifumi","family":"Notsu","sequence":"additional","affiliation":[{"name":"Clinical Research Center Shizuoka Cancer Center  Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9717-0281","authenticated-orcid":false,"given":"Waku","family":"Hatta","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Tohoku University Graduate School of Medicine  Sendai Miyagi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirotada","family":"Akiho","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kitakyushu Municipal Medical Center  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7272-0187","authenticated-orcid":false,"given":"Masao","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Division of Endoscopy Shizuoka Cancer Center  Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Horiuchi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Cancer Institute Hospital of Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8197-2295","authenticated-orcid":false,"given":"Takashi","family":"Kanesaka","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Oncology Osaka International Cancer Institute  Osaka 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