行内镜黏膜下剥离术治疗的近端早期胃癌患者临床病理特征分析

Clinicopathologic characteristics of proximal early gastric cancer treated by endoscopic submucosal dissection

目的观察行内镜黏膜下剥离术治疗的近端早期胃癌与远端早期胃癌患者的临床病理特征,为临床诊治提供依据。方法行内镜黏膜下剥离术治疗的早期胃癌和/或高级别上皮内瘤变患者211例,其中近端早期胃癌患者134例为近端早期胃癌组,远端早期胃癌患者77例为远端早期胃癌组,评估2组治愈性切除情况,非治愈性切除患者采用日本eCura评分系统评估淋巴结转移风险;比较2组肿瘤直径、肿瘤内镜分型、浸润深度、组织分化类型等临床病理特征及治愈性切除率、非治愈性切除者淋巴结转移风险。结果近端早期胃癌组肿瘤直径[(1.92±1.18)mm]小于远端早期胃癌组[(2.34±1.76)mm](t=—2.070,P=0.038),肿瘤内镜分型Ⅱb型、黏膜下层浸润、分化型比率(28.4%、20.1%、99.3%)均高于远端早期胃癌组(10.4%、7.8%、92.2%)(P<0.05),年龄、性别比例、淋巴管浸润、静脉浸润、合并溃疡、垂直切缘阳性、水平切缘阳性比率与远端早期胃癌组比较差异均无统计学意义(P>0.05)。近端早期胃癌组治愈性切除97例(72.4%),非治愈性切除37例,其中淋巴结转移风险低危30例,中危5例,高危2例;远端早期胃癌组治愈性切除53例(68.8%),非治愈性切除24例,其中淋巴结转移风险低危19例,中危4例,高危1例;近端早期胃癌组治愈性切除率、非治愈性切除者淋巴结转移风险与远端早期胃癌组比较差异均无统计学意义(χ^(2)=0.301,P=0.583;χ^(2)=0.150,P=0.928)。结论近端早期胃癌肿瘤直径较远端早期胃癌小,多为浅表平坦型、黏膜下层浸润及分化型,非治愈性切除患者淋巴结转移风险与远端早期胃癌无明显差异。

Objective To observe the clinicopathological characteristics of proximal early gastric cancer(PEGC)and distal early gastric cancer(DEGC)treated by endoscopic submucosal dissection(ESD),and to provide the basis for clinical diagnosis and treatment.Methods Totally 211 patients with early gastric cancer and/or high-grade intraepithelial neoplasia underwent endoscopic submucosal dissection,and were divided into PEGC group(n=134)and DEGC group(n=77).The curative resection was evaluated,and the risk of lymph node metastasis in patients with non-curative resection was predicted with Japanese eCura scoring system.The clinicopathological characteristics as tumor diameter,tumor endoscopic classification,depth of invasion and tissue differentiation types,the rate of curative resection and the risk of lymph node metastasis in non-curative resection patients were compared between two groups.Results The tumor diameter was shorter in PEGC group[(1.92±1.18)mm]than that in DEGC group[(2.34±1.76)mm](t=-2.070,P=0.038).The percentages of patients with endoscopic tumor subtypeⅡb,submucosal invasion,and differentiated type were higher in PEGC group(28.4%,20.1%,99.3%)than those in DEGC group(10.4%,7.8%,92.2%)(P<0.05).There were no significant differences in the age,gender ratio,lymphatic vessel invasion,venous infiltration,ulcer combination,positive rate of vertical margin and positive rate of horizontal margin between two groups(P>0.05).In PEGC group,97 paitents(72.4%)achieved curative resection,and 37 achieved non-curative resection,in which the risk of lymph node metastasis was low in 30 patients,intermediate in 5,and high in 2.In DEGC group,53 patients(68.8%)achieved curative resection,and 24 achieved non-curative resection,in which the risk of lymph node metastasis was low in 19,intermediate in 4,and high in 1.There were no significant differences in the rate of curative resection and the risk of lymph node metastasis in non-curative resection patients between two groups(χ^(2)=0.301,P=0.583;χ^(2)=0.150,P=0.928).Conclusions The diameter of PEGC is shorter than that of DEGC,and more of PEGC are in superficial flat type,submucosa infiltration and differentiated type.The risk of lymph node metastasis in patients with non-curative resection is almost the same in PEGC and DEGC.