368例内镜切除早期食管癌及癌前病变回顾性分析

Early esophageal cancer or precancerous lesions treated by endoscopic resection: a single-center retrospective study of 368 cases

目的回顾性分析内镜下切除的食管鳞状上皮病变的临床病理学特征与预后。方法收集2007~2013年接受内镜切除治疗的368例早期食管癌或癌前病变患者,分析其临床病理学特征。Kaplan-Meier法构建生存曲线,单因素和多因素Cox回归模型分析独立的预后因素。结果男性252例,女性116例,中位年龄61岁(16~84岁)。诊断为增生、上皮内瘤变低级别、上皮内瘤变高级别、上皮内癌(m1)、黏膜固有层浸润癌(m2)、黏膜肌层浸润癌(m3)、黏膜下浸润深度超过200μm(sm2)和黏膜下浸润深度不超过200μm(sm1)的病例数分别为47(12.8%)、61(16.6%)、61(16.6%)、54(14.7%)、38(10.3%)、63(17.1%)、12(3.3%)与32(8.7%)例。1年、3年和5年累积异时性食管病变发生率分别为4.1%、12.9%和32.6%。淋巴结或远处转移率在m3为1.54%,sm2为6.25%。1年、3年及5年总生存率分别为99.5%、97.3%和87.5%。sm2与非sm2患者转移率差异有显著性(P=0.021);但m3和sm2差异无显著性(P=0.252)。sm2和非sm2患者异时性食管病变发生率及生存率差异有显著性(P=0.401和P=0.634)。结论食管浅表鳞状上皮肿瘤内镜下切除是一种有效、相对安全的治疗手段,在特定的sm2患者,内镜切除依然是合适的;需要随访监测sm2患者第二原发肿瘤。

Purpose To investigate the clinicopathological features as well as prognosis of early esophageal squamous cell neoplasm （ESCN） treated with endoscopic resection （ER）. Methods 368 patients were collected from 2007 to 2013. Clinicopathological features including invasion depth and margin were evaluated. Survival curves were constructed by using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazard regression models were performed to identify asso-ciations with outcome variables. Results There were 252 males and 116 females with a median age of 61 （16-84） years. Patient numbers of hyperplasia, low grade intraepithelial neoplasia, high grade intraepithelial neoplasia, m1, m2, m3, sm1 and sm2 were 47（ 12. 8% ）, 61（16. 6% ）, 61（16. 6% ）, 54（ 14. 7% ）, 38（10.3%）, 63（17.1%）, 12（3.3%） and32（8.7%）, respectively. The cumulative overall 1-year, 3-year, and 5-year rates of survival in the metachronous esophageal lesions were 4. 1% , 12. 9% and 32.6% , respectively. The incidence of lymph node/distant metastasis was 1.54% in m3, 6. 25% in sm2, and 0 in other subgroups. The overall 1-year, 3-year, and 5-year survival rates were 99. 5% , 97.3% , and 87.5% , respectively. Significant difference was identified between sm2 and non-sm2 patients in metastatic rate （ P = 0. 021 ）, however, no significant difference existed between m3 patients and sm2 patients （ P = 0. 252 ）. Metaehronous esophageal lesion and survival between sin2 and non-sm2 patients demonstrated no statistical difference （P =0. 401 and P =0. 634）. Conclusion ER is an effective and relatively safe treatment for superficial ESCN. The procedure is still appropriate in selecting sm2 patients. It is necessary to monitor the second primary cancer in sm2 patients during follow-up.