早期胃癌患者ESD术后异时性胃癌发生情况及相关影响因素分析

Occurrence of postoperative heterochronic gastric cancer in patients with early gastric cancer treated by endoscopic submucosal dissection and analysis of related influencing factors

目的:分析内镜黏膜下剥离术(ESD)治疗早期胃癌患者术后异时性胃癌发生情况,并探讨其相关影响因素。方法:选取2016年5月—2021年5月某院行内镜黏膜下剥离术治疗的542例早期胃癌患者为研究对象,根据术后12个月后是否出现新病变分为异时性胃癌组和非异时性胃癌组。采用单因素及多因素Logistic回归分析,探讨ESD术后异时性胃癌发生的影响因素。结果:内镜黏膜下剥离术治疗早期胃癌,患者术后异时性胃癌发生率为11.07%(60/542)。单因素分析结果显示,2组在年龄、术后病理分化程度、初始病变位置、肠化程度、胃黏膜萎缩程度、有无HP感染方面比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄≥65岁(OR=6.028,95%CI=2.365~15.363)、分化型胃癌(OR=11.689,95%CI=5.633~24.255)、初始病变位于胃下1/3(OR=16.546,95%CI=7.682~35.638)、重度肠化(OR=4.234,95%CI=1.258~14.253)、O型胃黏膜萎缩(OR=3.444,95%CI=1.386~9.429)、有HP感染(OR=14.144,95%CI=5.214~38.366)是术后发生异时性胃癌的危险因素。结论:内镜黏膜下剥离术治疗早期胃癌,患者术后异时性胃癌发生率较高,年龄、术后病理分化程度、初始病变位置、肠化程度、胃黏膜萎缩程度、HP感染影响术后异时性胃癌发生,临床可据此制定术后长期随访与治疗策略,以提升内镜黏膜下剥离术治愈率,进一步改善预后。

Objective:To analyze the occurrence of postoperative heterochronic gastric cancer in patients with early gastric cancer treated by endoscopic submucosal dissection(ESD)and to discuss the related influencing factors.Methods:542 patients with early gastric cancer treated by ESD in a hospital from May 2016 to May 2021 were followed up and divided into a heterochronic gastric cancer group and a non-heterochronic gastric cancer group according to whether new lesions appeared after more than 12 months after surgery.General data of the patients were analyzed univariately,and factors influencing the occurrence of heterochronic gastric cancer after surgery were explored by logistic regression.Results:The incidence of postoperative heterochronic gastric cancer in patients with early gastric cancer treated by ESD was 11.07%(60/542).Univariate analysis showed that differences in age,degree of postoperative pathological differentiation,location of initial lesion,degree of intestinalization,degree of gastric mucosal atrophy,and presence of HP infection between the two groups were significant(P<0.05).By logistic regression equation analysis,age≥65 years(OR=6.028,95%CI=2.365 to 15.363),differentiated gastric cancer(OR=11.689,95%CI=5.633 to 24.255),initial lesion in the lower third of the stomach(OR=16.546,95%CI=7.682 to 35.638),severe intestinalization(OR=4.234,95%CI=1.258 to 14.253),type O gastric mucosal atrophy(OR=3.444,95%CI=1.386 to 9.429),and presence of HP infection(OR=14.144,95%CI=5.214 to 38.366)were risk factors for the development of heterochronic gastric cancer after surgery.Conclusion:Incidence of postoperative heterochronic gastric cancer is higher in patients with early gastric cancer treated by ESD.Age,degree of postoperative pathological differentiation,initial lesion location,degree of intestinalization,degree of gastric mucosal atrophy,and presence of HP infection affect the incidence of postoperative heterochronic gastric cancer.On this clinical basis,long-term postoperative follow-up and treatment strategies should be formulated to enhance the cure rate of ESD and effectively improve the prognosis.