早期胃癌内镜黏膜下剥离术非治愈性切除的危险因素分析

Risk factors of endoscopic submucosal dissection for non-curative resection of early gastric cancer

目的探讨早期胃癌(EGC)行内镜黏膜下剥离术(ESD)后非治愈性切除的危险因素。方法收集南昌大学第一附属医院消化内镜中心2010年12月至2018年12月行ESD的EGC(包括高级别上皮内瘤变)患者的临床、内镜及病理资料,采用单因素及多因素分析方法,分析与ESD非治愈性切除相关的危险因素。结果最终纳入EGC患者191例。ESD非治愈性切除率为24.61%(47/191)。Logistic回归分析发现肿瘤直径>20 mm(OR=10.187,95%CI:3.427~30.283)、溃疡形成(OR=3.850,95%CI:1.541~9.616)、未分化型癌(OR=11.915,95%CI:3.395~41.817)及浸润黏膜下层(OR=8.197,95%CI:2.186~30.737)是影响EGC内镜非治愈性切除的独立危险因素,随着危险因素的增加,内镜非治愈性切除率也随之增加。结论对于肿瘤直径>20 mm、溃疡形成、病理为未分化型癌及浸润黏膜下层的EGC患者,ESD应该更加谨慎。

Objective To investigate the risk factors of non-curative resection of early gastric cancer(EGC)after endoscopic submucosal dissection(ESD). Methods The clinical,endoscopic and pathological data of patients with EGC(including high-grade intraepithelial neoplasia)who underwent ESD between December 2010 and December 2018,at the Digestive Endoscopy Center of the First Affiliated Hospital of Nanchang University were retrospectively collected.Risk factors associated with ESD non-curative resection were analyzed by univariate and multivariate analysis. Results A total of 191 EGC were included.The incidence of ESD non-curative resection was 24.61%(47/191).Logistic regression analysis found that tumor diameter>20 mm(OR=10.187,95% CI:3.427~30.283),ulceration(OR=3.850,95% CI:1.541~9.616),undifferentiated carcinoma(OR=11.915,95% CI:3.395~41.817)and submucosal invasion(OR=8.197,95% CI:2.186~30.737)were independent risk factors for ESD non-curative resection of EGC,and with the increase of risk factors,the rate of non-curative resection also increased. Conclusion ESD should be more cautious for EGC patients with tumor diameter>20 mm,ulceration,undifferentiated tumor histology or submucosal invasion.