表浅胃食管交界腺癌内镜分型与浸润深度相关性分析

Correlation Between Endoscopic Macroscopic Type and Depth of Tumor Invasion for Superficial Adenocarcinoma of Esophagogastric Junction

目的探讨表浅胃食管交界腺癌（AEG）的临床病理特征与术后浸润深度之间的关系,评估表浅AEG的内镜分型对预测浸润深度的意义。方法分析2008年11月至2015年5月期间四川大学华西医院行内镜治疗或外科手术并经病理确诊的57例表浅AEG患者的临床病理资料,对其与浸润深度的关系进行分析。结果患者年龄48~76岁,平均（63.0±6.8）岁;男49例,女8例。肿瘤直径为3.0~40.0mm,平均（16.6±10.1）mm。黏膜内癌28例,黏膜下癌29例。两组年龄、性别、组织学分型、Siewert分型差异无统计学意义,肿瘤直径（P=0.02）和内镜分型（P=0.02）差异有统计学意义。进一步行多因素logistic回归分析显示,内镜分型为黏膜下层浸润的独立危险因素（P=0.041）,凹陷型表浅AEG发生黏膜下层浸润的风险是隆起型或平坦型的3.244倍（95%可信区间1.050~10.023）。结论表浅AEG的内镜分型对浸润深度的判断有一定意义。对于内镜分型以凹陷为主型的表浅AEG,特别是0-Ⅲ型,多有黏膜下层的浸润,其发生淋巴结转移风险高,不建议行内镜下治疗。

Objective To investigate the clinicopathologic characteristics of superficial adenocarcinoma of esophagogastric junction（AEG）,and to analyze the relationship between endoscopic macroscopic type and tumor depth for such cancers.Methods The clinical data of the 57 superficial AEG patients who underwent endoscopic resection or surgical operation between November 2008 and May 2015 in West China Hospital,Sichuan University were analyzed.Clinicopathologic features were compared between different depth of tumor invasion by univariate and multivariate analysis.Results The age ranged between 48 and 76yr.,with an average age of（63.0±6.8）yr.;49cases in male,8cases in female.The tumor size ranged between 3.0and 40.0mm,the average size was 16.6mm.The mucosal carcinoma was 28 cases,the submucosal carcinoma is 29 cases.There were no significant differences in age,gender,histological type and Siewert type in two groups,while there was statistical difference in tumor diameter（P=0.02）and endoscopic typing（P=0.02）between the two groups.The further multivariate analysis revealed that endoscopic macroscopic type（P=0.041）was an independent risk factor of superficial AEG invasion depth.The risk of submucosal invasion was 3.244 times in depressed type as large as in elevated or flat type of the superficial AEG（95% confidence interval：1.050-10.023）.Conclusion The endoscopic macroscopic type may be useful in accurately diagnosing superficial AEG invasion depth.For the endoscopic macroscopic type mainly of depression,especially the type 0-Ⅲ,which was more likely to infiltrate the submucosal and more likely to have lymph node metastasis,do not recommend to get an endoscopic treatment.