title: Prediction model for non-curative resection of endoscopic submucosal dissection in patients with early gastric cancer.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is a useful method for complete resection of early gastric cancer (EGC). However, there are still some patients who undergo additional gastrectomy after ESD because of non-curative resection. There is no model that can accurately predict non-curative resection of ESD. We aimed to create a model for predicting non-curative resection of ESD in patients with EGC.
  
  
  METHODS
  We reviewed the medical records, including all gross findings of EGC, of patients who underwent ESD for EGCs. We divided the patients into a non-curative resection group and a curative resection group. The clinicopathologic characteristics were compared between the groups to identify the risk factors for non-curative resection of ESD. We created a scoring system based on logistic regression modeling and bootstrap validation.
  
  
  RESULTS
  Of 1639 patients who had undergone ESD for EGCs, 272 were identified as being treated non-curatively with ESD. A large tumor size (≥20 mm), tumor location in the upper body of the stomach, the presence of ulcer, fusion of gastric folds, the absence of mucosal nodularity, spontaneous bleeding, and undifferentiated tumor histology were associated with non-curative resection of ESD. Points of risk scores were assigned for these variables based on the β coefficient as follows: tumor size (≥20 mm), 2 points; tumor location in the upper body of the stomach, 1 point; ulcer, 2 points; fusion of gastric folds, 2 points; absence of mucosal nodularity, 1 point; spontaneous bleeding, 1 point; and undifferentiated histology, 2 points. Our risk scoring model showed good discriminatory performance on internal validation (bootstrap-corrected area under the receiver operating characteristic curve, 0.7004; 95% confidence interval, 0.6655-0.7353).
  
  
  CONCLUSIONS
  We developed a validated prediction model that can be used to identify patients who will undergo non-curative resection of ESD. Our prediction model can provide useful information for making decisions about the treatment of EGC before performing ESD.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Eun Hye
authors.initials: EH
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jun Chul
authors.initials: JC
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: In Ji
authors.initials: IJ
authors.lastname: Song
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yeong Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Dong Hoo
authors.initials: DH
authors.lastname: Joh
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kyu Yeon
authors.initials: KY
authors.lastname: Hahn
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yong Kang
authors.initials: YK
authors.lastname: Lee
authors.affiliation: Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ha Yan
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hyunsoo
authors.initials: H
authors.lastname: Chung
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sung Kwan
authors.initials: SK
authors.lastname: Shin
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sang Kil
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Lee
mesh_terms: D000368:Aged; D019540:Area Under Curve; D003661:Decision Support Techniques; D000069916:Endoscopic Mucosal Resection; D005260:Female; D005743:Gastrectomy; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D005773:Gastroscopy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D012372:ROC Curve; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D017211:Treatment Failure; D047368:Tumor Burden; D014456:Ulcer / Q000453:epidemiology