大肠侧向发育型肿瘤癌变的临床病理相关风险因素研究

Research on the risk factors related with clinicopathology in canceration of colorectal laterally spreading tumors

目的明确大肠侧向发育型肿瘤(laterally spreading tumor,LST)的临床病理学特点,探索与其癌变密切相关的风险因素。方法回顾性分析2011年5月至2017年5月在海军军医大学附属长海医院消化内镜中心行肠镜检查符合LST诊断标准的患者及同期隆起型腺瘤(protruded-type adenoma,PA)患者的临床、病理资料。将LST及其亚型与PA对照分析其临床特点与癌变风险因素。结果 LST组患者共422名,病变439处;PA组患者共432名,病变465处。LST-G、LST-NG和PA的癌变率分别为7.72%、11.69%和2.58%。经回归分析研究LST和PA癌变的风险相关关系,发现形态学分型、发病部位和息肉直径3个因素是LST癌变的相关风险因素,形态学分型为LST-NG、病变位于左半肠及病变直径越大癌变风险越高;患者年龄、发病部位、息肉直径3个因素是PA癌变的相关风险因素,患者年龄越大、病变位于右半肠及息肉直径越大则癌变风险越高。结论 LST与PA相比存在更高的恶性潜能,尤其是LST-NG;LST与PA的癌变风险因素存在明显的不同,提示LST与PA可能存在完全不同的癌变机制。

Objective To identify clinicopathological features of laterally spreading tumors（LST） and explore the canceration risk factors related with LSTs. Methods A retrospective analysis of clinical and pathological data was made in the patients,who underwent colonoscopy from May 2011 to May 2017 in the Digestive Endoscopy Center of Changhai Hospital and were conformed to the diagnostic criteria of LST and protruded-type adenoma（ PA）. Clinical features and related canceration risk factors of LST and its subtype were analyzed and compared with those of PA. Results In the LST group,there were 422 patients,with a total of 439 LST lesions,and in the PA group,there were 432 patients with 465 lesions. Canceration rates of the LST-G group,the LST-NG group and the PA group were respectively 7. 72%,11. 69% and 2. 58%. Regression analysis indicated that the canceration risk factors of LST were associated with those of PA,and morphological classification,pathogenic sites and polyp size were related canceration risk factors in LST. Morphological typing was LST-NG and pathogenic site was located at the left half colon,and the larger its size,the greater the canceration risk. Patient age,pathogenic site and polyp size were 3 canceration related risk factors of PA. Old age,pathogenic location at the right half colon and larger polyp size were high canceration risk factors. Conclusion LST seems to have greater malignant potential than PA,especially the LST-NG type. The canceration risk factors of LST and PA are obviously different,indicating that the canceration mechanism of LST and PA might be entirely different.