ObjectiveTo verify the clinical applicability of "eCura system", a scoring system for assessing the risk of lymph node metastasis after non-curative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). MethodsA retrospective analysis was performed on clinicopathological data of 155 patients with EGC, who underwent non-curative ESD confirmed by postoperative pathology in Drum Tower Hospital Affiliated to Medical School of Nanjing University from January 2012 to March 2018. According to the eCura scoring system, the 155 patients were divided to three groups: 100 cases in the low-risk group (0 to 1 point), 46 cases in the intermediate-risk group (2 to 4 points), and 9 cases in the high-risk group (5 to 7 points). Lymph node metastasis rates and prognosis of the three groups were observed and compared. ResultsThe follow-up time of the 155 patients was 25±15.0 months, of which median follow-up time was 25 months in the low-risk group, 23 months in the intermediate-risk group, and 34 months in the high-risk group. A total of 57 patients underwent additional surgery in the low-risk group, including 3 cases [5.26% (3/57)] of lymph node metastases; 29 patients underwent additional surgery in the intermediate-risk group, including 2 cases [6.90% (2/29)] of lymph node metastases; all 9 patients in the high-risk group underwent additional surgery and 4 cases had lymph node metastasis. Multivariate Logistic regression analysis showed that the risk of lymph node metastasis in the high-risk group was significantly higher than that in the low-risk group (P=0.003, OR=14.499, 95%CI: 2.513-97.214), while the risk of lymph node metastasis in the intermediate-risk group was slightly higher than that in the low-risk group (P=0.767, OR=1.326, 95%CI: 0.165-8.594). During follow-up, there was no metastasis or cancer-specific mortality in the low-risk group, and recurrence was found in 3 cases [6.98% (3/43)] of the 43 patients without additional surgery. Among the 17 patients in the intermediate-risk group, who did not undergo additional surgery, 1 case [5.88% (1/17)] had recurrence and 2 cases [11.76% (2/17)] had metastasis including 1 case [5.88% (1/17)] died of brain metastasis. There was no recurrence, metastasis or cancer-specific mortality in 29 patients in the intermediate-risk group, who underwent additional surgery during follow-up. And there was no recurrence, metastasis or cancer-specific mortality in the all 9 patients in the high-risk group received additional surgery after ESD during follow-up. ConclusionThe eCura scoring system could contribute to predict the lymph node metastasis risk in patients after non-curative ESD for EGC. The benefits of additional surgery are limited for low-risk patients, while for intermediate-risk and high-risk patients, additional surgery can effectively improve prognosis.