同时性多发早期食管癌及高级别上皮内瘤变的临床特征和病灶的关联性分析

Clinical Characteristics and Correlation Analysis of Synchronous Multiple Early Esophageal Cancers and High Grade Intraepithelial Neoplasia

目的探讨同时性多发早期食管癌(EEC)及同时性多发高级别上皮内瘤变(HGIN)的临床特征以及主要病灶与次要病灶之间的关联性。方法收集2014年8月至2020年6月就诊于郑州大学第一附属医院并行内镜黏膜下剥离术(ESD)治疗的同时性多发EEC及HGIN患者,将多发病灶分为主要病灶与次要病灶。比较多发EEC及HGIN患者的临床特征,采用Pearson、Spearman相关分析主要病灶与次要病灶在浸润深度、大小、位置、病理类型等方面的关联性。结果纳入研究的EEC及HGIN患者共341例,其中同时性多发EEC及HGIN患者21例,平均年龄为(66.90±6.04)岁,男性14例(66.67%)。多发病变患者年龄>65岁的占比高于单发病变患者,差异有统计学意义(χ2=4.299,P=0.038)。主要病灶与次要病灶的面积大小呈线性正相关(r=0.612,P=0.003)。当主要病灶位于胸上段时,次要病灶位于胸中段的可能性较大,两者有关联性(r=0.484,P=0.025)。主、次要病灶在浸润深度、病理类型方面有一定的关联性(P<0.05)。结论同时性多发早期食管癌及高级别上皮内瘤变患者的主要病灶与次要病灶在浸润深度、大小、位置、病理类型方面有一定的关联性,且年龄>65岁的老年患者更易发生多发病变。在内镜检查时,应考虑主要病灶与次要病灶的关系,避免忽视次要病灶。

Objective To investigate the clinical features and correlation between major and minor lesions of synchronous multiple early esophageal cancers(EEC)and high grade intraepithelial neoplasia(HGIN).Methods Collect the medical records of patients with synchronous multiple EEC and HGIN for endoscopic submucosal dissection(ESD)in the First Affiliated Hospital of Zhengzhou University from August 2014 to June 2020.Multiple lesions were divided into major and minor lesions.The clinical characteristics of multiple EEC and HGIN patients were compared,and the correlation between the major and minor lesions in infiltration depth,size,location,pathological types were analyzed by Pearson and Spearman correlation.Results A total of 341 patients with EEC and HGIN were included in the study,including 21 patients with multiple EEC and HGIN.The average age was(66.90±6.04)years,and there were 14 males(66.67%).The proportion of patients with multiple lesions older than 65 years were higher than that of patients with single lesions,and the difference was statistically significant(χ2=4.299,P=0.038).The size of the major and minor lesions showed a linear positive correlation(r=0.612,P=0.003).When the major lesion was located in the upper thoracic segment,the minor lesion was more likely to be located in the middle thoracic segment(r=0.484,P=0.025).The depth of invasion and pathological type between major and minor lesions demonstrated a significant correlation(P<0.05).Conclusion In patients with multiple EEC and HGIN,it showed a significant correlation between the major and minor lesions in depth of tumor invasion,tumor size,pathological type and tumor location.Moreover,patients older than 65 years are more likely to have multiple lesions.Therefore,the relationship between the major and minor lesions should be considered during endoscopic examination.