食管黏膜白色苔藓样病变是早期食管癌及癌前病变ESD术后切缘阳性的危险因素

White lichenoid lesions of esophageal mucosa are a risk factor for positive margins after endoscopic submucosal dissection for early carcinoma and precancerous lesions of esophagus

目的:探讨早期食管癌及癌前病变合并白色苔藓样病变患者临床、内镜及组织病理学特征。方法:回顾性分析2017年9月至2021年8月于四川省南充市川北医学院附属医院行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗且术后病理诊断为早期食管癌及癌前病变患者资料。共198例患者纳入研究,通过内镜下判断是否合并白色苔藓样病变,分为2组,分析其临床、内镜及组织病理学特征有无差异。结果:198例早期食管癌及癌前病变患者中有119例合并白色苔藓样病变,并与ESD术后切缘阳性有关(P=0.032)。ESD术后标本切缘阳性34例,进一步行多因素分析,发现合并有白色苔藓样病变(P=0.036)、病变累计管周范围(>3/4管周,P<0.001)、术后病理(黏膜内癌以下,P=0.002)、病变浸润深度(M3以下,P<0.001)是早期食管癌及癌前病变患者ESD术后切缘阳性的独立危险因素。结论:早期食管癌及癌前病变合并白色苔藓样病变患者ESD术后切缘阳性风险性增加;病变累计管周范围>3/4管周、病变浸润深度是切缘阳性的独立危险因素。

Objective:To investigate the clinical,endoscopic,and histopathological features of patients with early esophageal cancer and precancerous lesions having white lichenoid lesions.Methods:The data from patients who underwent endoscopic submucosal dissection(ESD)between September 2017 and August 2021,and from patients who were pathologically diagnosed with early esophageal cancer and precancerous lesions after surgery were retrospectively collected.A total of 198 patients were included in the study to determine whether they had white lichenoid lesions by endoscopy.The patients were assigned into two groups and were analyzed based on their differences in clinical,endoscopic,and histopathological characteristics.Results:Of the 198 patients with early esophageal cancer and precancerous lesions,119 had white lichenoid lesions.The lesions were significantly associated with positive margins after ESD(P=0.032).Thirty-four specimens had positive margins after ESD.Multivariate analysis revealed that the combination of white lichenoid lesions(P=0.036),cumulative peritubular extent of lesions(>3/4 peritubular area,P<0.001),postoperative pathology(below intramucosal cancer,P=0.002),and depth of lesion invasion(below M3,P<0.001)were independent risk factors for positive margins after ESD.Conclusions:Patients with early esophageal cancer and precancerous lesions having white lichenoid lesions were at an increased risk of positive margins after ESD.In addition,the cumulative peritubular range of lesions>3/4 peritubular area and the depth of lesion invasion were independent risk factors for positive margins.