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Clinical calculator summary

JGCA eCura classification

A post-endoscopic-resection histopathologic decision table for gastric adenocarcinoma.

Evidence-based context for fast calculator use

Purpose:
Reproduce the JGCA 2021 sixth-edition eCura A/B/C-1/C-2 classification.
Population:
Resected gastric adenocarcinoma assessed histopathologically after EMR or ESD under the JGCA sixth edition.
Factors:
En-bloc status, Horizontal and vertical margins, Lymphatic or venous invasion, Histology, depth, ulceration, size, and relevant mixed components
Reference:
Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition). DOI: 10.1007/s10120-022-01331-8.
HomeJGCA eCura Classification After Endoscopic Resection (2021)
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JGCA eCura Classification After Endoscopic Resection (2021)

Enter the raw positive size without rounding; the decision table uses 2 cm and 3 cm boundaries.

Controls the differentiated pT1a UL0 pathway. Select “Not assessed” when that required pathology detail is unresolved.

Controls the differentiated SM1 pathway. Select “Not assessed” when that required pathology detail is unresolved.

Clinical Context & Background

This calculator implements the Japanese Gastric Cancer Association 2021 sixth-edition histopathologic curability classification after gastric EMR or ESD for resected adenocarcinoma.
It distinguishes eCura A, eCura B, eCura C-1, and eCura C-2 using en-bloc status, separate horizontal and vertical margins, lymphatic or venous invasion, dominant histology, pathologic depth, ulceration, raw tumor size, and relevant undifferentiated components. Differentiated histology includes pap, tub1, and tub2; undifferentiated histology includes por1, por2, and sig. A mucinous component in the submucosal invasive portion is treated as undifferentiated.
This is not a pretreatment staging tool, a classifier for non-adenocarcinoma lesions, the separate 2017 eCura lymph-node-metastasis risk score, or an autonomous treatment recommendation. Missing relevant mixed-histology assessment returns Insufficient pathology rather than eCura C-2.
Primary Source EvidenceJapanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition). Gastric Cancer. 2023;26:1-25. DOI: 10.1007/s10120-022-01331-8.
Formula Logic
JGCA 2021 sixth-edition post-EMR/ESD histopathologic decision table: eCura A, eCura B, eCura C-1, or eCura C-2.

Reference Data

ClassificationSixth-edition definition
eCura AComplete en-bloc resection with HM0, VM0, Ly0/V0 and a qualifying pT1a pathway
eCura BComplete differentiated SM1 (<500 um), <=3 cm resection without an undifferentiated component in SM
eCura C-1Differentiated A/B pathway with non-en-bloc resection and/or HM1 as the only defect
eCura C-2Every other fully resolved combination

Clinical Workflow

Use, Interpret, And Continue The Patient Pathway

Expand for workflow guidance, limitations, examples, and related next steps.

When To Use

  • Use final post-EMR/ESD pathology for resected gastric adenocarcinoma.
  • Use raw tumor size without rounding and assess relevant mixed histology.

How To Interpret

  • A and B require en-bloc resection, HM0, VM0, and Ly0/V0.
  • C-1 is limited to differentiated A/B lesions whose only defect is non-en-bloc resection and/or HM1.

What To Do Next

  • Document the complete pathology and classification.
  • Review management using the full JGCA guideline and multidisciplinary clinical context.

Limitations

  • Not for pretreatment selection, non-adenocarcinoma, or incomplete relevant pathology.
  • Not the separate eCura lymph-node-metastasis risk score and not an autonomous treatment decision.

Validated Population

Resected gastric adenocarcinoma assessed histopathologically after EMR or ESD under the JGCA sixth edition.

Boundary example

A differentiated SM1 lesion measuring exactly 3.0 cm can qualify as eCura B; a lesion over 3.0 cm cannot.

Calculation verification history

Verified

  1. : Production browser revalidation

    • Three source-backed production cases passed across eCura A, the just-above-2-cm eCura C-2 transition, and the exact 3-cm eCura B boundary.
    • Every visible input was exercised through the production form and the decision trace no longer displays synthetic zero point values.
    • No unexpected N/A, stale control, literal undefined/null value, or browser-console error was observed.
    Download latest production check (Excel)

    Case-level evidence is retained in validation/browser-revalidation/jgca-egc-gastric-risk-2026-08-03.json.

  2. : Decision-table receipt corrected and browser-revalidated locally

    • Removed the synthetic zero-point field from all ten pathology breakdown rows; the receipt now presents each actual pathology value as evaluated by the published rule.
    • Insufficient mixed-histology assessment now shows an authored eCura-class-not-assigned receipt instead of generic missing-or-invalid-input wording.
    • Ten visible-browser cases passed across 11 submissions, covering all four eCura classes, raw 2 cm and 3 cm transitions, insufficient pathology, and reset/repeat; the source audit remains 1,289/1,289.

    Case-level local remediation evidence is retained in validation/browser-production/jgca-egc-gastric-risk.local-remediation.json; the original production finding remains retained separately.

  3. : Production browser validation

    • Ten source-backed cases were exercised on the public production route through visible browser controls; 1/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
    • Overall browser status: failed-ui-and-console. high: Every applicable eCura result displayed a bold `0` beside each of the ten pathology fields in the visible Value / Decision column even though eCura is a decision table with no additive point system. | medium: Production emitted minified React error #418 during route loads/reloads used by this run.
    • Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.

    Case-level production evidence is retained in validation/browser-production/jgca-egc-gastric-risk.json.

  4. : Full validation test

    • 1,289/1,289 source-table, exhaustive resolved-state, mixed-component, boundary, malformed-input, UI, trace, registry, report, history, and isolation checks passed.
    • This verifies implementation against the cited JGCA model; it is not independent clinical validation, regulatory approval, or medical advice.

  5. : Calculation and input-contract correction

    • Corrected the post-EMR/ESD eCura A/B/C-1/C-2 logic and the inclusive 2 cm and 3 cm boundaries.
    • Added en-bloc status, separate horizontal and vertical margins, and both source-required mixed-histology assessments.
    • Removed favorable defaults, coercion, inaccurate curability labels, and prescriptive fixed-surgery wording; relevant unassessed pathology now returns Insufficient pathology.

    Included in the current validation report.

Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.

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Frequently Asked Questions

When should JGCA eCura Classification After Endoscopic Resection (2021) be used?

Use it for patients undergoing gastric or pancreatic cancer pathology, recurrence, or postoperative prognostic assessment when all required inputs and the intended clinical setting are confirmed.

Can JGCA eCura Classification After Endoscopic Resection (2021) determine treatment by itself?

No. Interpret the result with the cited evidence, complete clinical assessment, current guidelines, and patient-specific goals.

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