早期胃食管结合部癌行内镜黏膜下剥离术后非治愈切除的危险因素分析

Risk factors of postoperative non-curative resection for early gastroesophageal junction cancer after endoscopic submucosal dissection

目的:探讨早期胃食管结合部(gastroesophageal junction,GEJ)癌行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)后非治愈切除的危险因素。方法:选择2016年10月至2020年9月于福建省立医院消化内镜中心行ESD的早期GEJ癌患者114例,根据术后病理检查结果将其分为治愈性切除组和非治愈性切除组,对患者性别、年龄、肿瘤直径、肿瘤形态、病理类型、浸润深度以及是否合并溃疡等进行比较,对可能影响非治愈性切除的相关因素进行Logistic回归分析;对独立危险因素的数量与非治愈性切除率进行Spearman相关分析。结果:两组在性别、年龄、病变形态、病灶位置、深在性囊性胃炎、背景炎症方面均无统计学差异(P均>0.05)。肿瘤直径、黏膜下浸润、溃疡、病理类型和黏膜下纤维化差异有统计学意义(P均<0.05)。多因素回归分析显示,肿瘤直径(>2 cm)、黏膜下浸润、溃疡、未分化癌是早期GEJ癌非治愈性切除的独立危险因素(P<0.05)。独立危险因素的数量与术后非治愈性切除发生率相关(r_(s)=0.492,P<0.01),危险因素数量越多,非治愈性切除率越高。结论:肿瘤直径(>2 cm)、黏膜下浸润、溃疡、未分化癌是早期GEJ癌ESD治疗后非治愈性切除的独立危险因素;风险因素的数量越多,非治愈性切除的比例越高。

Objective:To investigate the risk factors of non-curative resection of early-stage gastroesophageal junction(GEJ)cancer after endoscopic submucosal dissection(ESD).Methods:A total of 114 patients with early GEJ cancer who underwent ESD in the Digestive Endoscopy Center of Fujian Provincial Hospital from October 2016 to September 2020 were selected and divided into the curative resection group and the non-curative resection group,according to the postoperative pathological examination results.The gender,age,tumor diameter,tumor morphology,pathological type,depth of invasion and whether there was ulcer,etc.were compared between the two groups.Logistic regression analysis was used to figure out the related factors that may be associated with non-curative resection.Spearman correlation analysis was performed between the number of independent risk factors and the rate of non-curative resection.Results:There were no significant differences between the two groups in terms of gender,age,lesion shape,lesion location,deep cystic gastritis and background mucositis(all P>0.05),while tumor diameter,submucosal infiltration,ulcer,pathological type and submucosal fibrosis were signifcantly different(all P<0.05).Logistic analysis showed that tumor diameter(>2 cm),submucosal infiltration,ulcer and undifferentiated carcinoma are independent risk factors for non-curative resection of early GEJ cancer.The number of independent risk factors was correlated with the incidence of postoperative non-curative resection(r_(s)=0.492,P<0.01),the more risk factors,the higher non-curative resection rate.Conclusion:Tumor diameter(>2 cm),submucosal infiltration,ulcer and undifferentiated carcinoma are independent risk factors for non-curative resection after ESD for early-stage GEJ cancer;the greater the number of risk factors,the higher the propotion of non-curative resection.