Early Gastric Cancer in the Spanish EURECCA Registry

Overview

Early gastric cancer (EGC) is increasingly diagnosed in Western countries; however, important differences remain with Eastern populations regarding staging accuracy, treatment strategies, and the risk of lymph node metastasis. While endoscopic resection is the standard treatment for selected EGC in Asia based on well-established criteria, the applicability of these criteria to Western populations remains uncertain because of differences in epidemiology, clinical practice, and pathological characteristics. This multicenter retrospective cohort study, based on the Spanish EURECCA Registry, aims to evaluate the concordance between clinical and pathological staging, determine the real incidence and predictors of lymph node metastasis in patients with pathological T1 gastric cancer, assess the applicability of standard and expanded Asian endoscopic resection criteria in a Western cohort, and analyze long-term oncological outcomes, including recurrence and overall survival.

Early gastric cancer (EGC) is defined as gastric adenocarcinoma confined to the mucosa or submucosa regardless of lymph node status. Although endoscopic resection has become the standard treatment for selected patients in Eastern countries, its use in Western populations remains controversial because most recommendations are based on Asian cohorts with different epidemiological characteristics, screening strategies, and clinical practice. Accurate preoperative staging is essential for selecting the optimal therapeutic approach. However, the concordance between clinical staging and final pathological findings remains suboptimal, particularly regarding depth of invasion and lymph node involvement. These limitations may result in both overtreatment and undertreatment of patients with EGC. The Spanish EURECCA Registry provides a large multicenter cohort of surgically treated patients with standardized clinicopathological data collected from routine clinical practice. This study will evaluate the agreement between clinical and pathological staging, characterize the risk factors associated with lymph node metastasis, retrospectively assess the applicability of standard and expanded Asian endoscopic resection criteria in a Western population, and investigate long-term oncological outcomes. The results are expected to provide evidence supporting treatment decision-making and the potential implementation of less invasive therapeutic strategies in appropriately selected Western patients.