结直肠侧向发育型肿瘤的临床病理特征及癌变的危险因素分析

Clinicopathologic features of colorectal laterally spreading tumor and analysis on risk factors of cancerization

目的分析结直肠侧向发育型肿瘤(laterally spreading tumor,LST)的临床病理特征及癌变的危险因素。方法回顾性分析2016年6月至2022年6月在兰州大学第二医院经内镜诊断为结直肠LST并行内镜下治疗或外科手术治疗的213例患者的临床资料。总结LST的临床病理特征,并通过logistic多因素回归分析探讨LST癌变的危险因素。结果共纳入213例患者(224个病灶),≥60岁患者比例为64.3%,男性比例为57.7%,发病部位以右半结肠最为常见(42.4%)。不同亚型的临床病理学特征不同,结节混合型最为常见(107处,47.8%),其次为扁平隆起型(67处,29.9%),颗粒均一型(38处,17.0%),假凹陷型最少(12处,5.4%)。结节混合型的直径[(2.90±1.31)cm]大于颗粒均一型、扁平隆起型及假凹陷型[分别为(2.44±1.13)cm,(1.63±0.64)cm,(1.96±0.63)cm],差异有显著性(P<0.001)。假凹陷型的癌变率最高(75.0%),其次为结节混合型(73.8%),颗粒均一型和扁平隆起型的癌变率较低(分别为34.2%、23.9%),差异有显著性(P<0.001)。假凹陷型浸润性癌的发生率(33.3%)明显高于结节混合型(10.3%)、扁平隆起型(6.0%)、颗粒均一型(0%),差异有显著性(P=0.005)。多因素logistic回归分析显示,病变为假凹陷型、结节混合型,病变直径≥2.0cm是LST发生癌变的独立危险因素。结论LST是一种特殊的结直肠肿瘤,具有独特的临床病理特征,不同亚型的临床病理特征不同。当病变为假凹陷型、结节混合型或病变直径≥2.0cm时易发生癌变。

Objective To analyze the clinicopathological features and cancerization risk factors of colorectal laterally spreading tumor(LST).Method From June 2016 to June 2022,the clinical data of patients diagnosed with colorectal LST by endoscopy and treated with endoscopic treatment or surgical treatment were retrospectively analyzed.The clinical characteristics of LST were summarized,and univariate and logistic multivariate regression analysis were carried out to explore the influencing factors of malignant degeneration of LST.Result A total of 224 lesions were included in 213 patients,the proportion of patients≥60 years old was 64.3%,and that of males was 57.7%.The most common site of the disease was the right colon(42.4%).The clinicopathological characteristics of different subtypes were different.LST-GM was the most common(107,47.8%),followed by LST-NG-F(67,29.9%),LST-GM(38,17.0%),and LST-NG-PD at least(12,5.4%).The diameter of lesions in LST-GM was larger than that in LST-GH,LST-NG-F and LST-NG-PD[(2.44±1.13)cm,(1.63±0.64)cm,(1.96±0.63)cm],and the difference was significant(P<0.001).The canceration rate of LST-NG-PD was the highest(75.0%),followed by LST-GM(73.8%),the canceration rate of LST-GH and LST-NG-F was lower(34.2%and 23.9%,respectively),and the difference was significant(P<0.001).The incidence of LST-NG-PD infiltrating carcinoma(33.3%)was significantly higher than that of LST-GM(10.3%),LST-NG-F(6.0%)and LST-GH(0%),and the difference was significant(P=0.005).Multivariate logistic regression analysis showed that the lesions were LST-NG-PD and LST-GM,and the diameter≥2.0cm was an independent risk factor for LST carcinogenesis.Conclusion LST is a special colorectal tumor with unique clinicopathologic features,which are different in different subtypes.When the lesion was LST-NG-PD,LST-GM,or≥2.0cm in diameter,it was prone to malignant degeneration.