食管癌内镜黏膜下剥离术后复发的影响因素分析

Influencing factors of recurrence after endoscopic submucosal dissection for esophageal cancer

目的探讨食管癌内镜黏膜下剥离术(ESD)后复发情况及相关影响因素。方法前瞻性选取2018年1月-2020年10月该院100例行食管癌ESD的患者作为研究对象,通过电话或门诊复查方式,随访术后1年复发情况,采用Logistic回归方程分析术后复发的影响因素,利用R软件建立预测食管癌ESD后复发的列线图模型。结果术后1年随访,100例患者中失访6例,复发率为10.64%;病变直径≥3.11 cm、SM1癌、病变内镜下混合型、术中重度粘连、术前无法进食和术后存在脉管瘤栓,是食管癌ESD后复发的高危因素(P<0.05);对列线图模型进行验证,其初始C指数为0.876,校正曲线显示,该列线图模型具有良好的区分度和一致性。结论基于病变直径≥3.11 cm、SM1癌、病变内镜下混合型、术中重度粘连、术前无法进食和术后存在脉管瘤栓6个高危因素,构建个体化预测食管癌ESD后复发风险的列线图模型,可准确地识别术后复发风险,指导临床诊断和治疗。

Objective To investigate the recurrence and related factors of esophageal cancer after endoscopic submucosal dissection(ESD).Methods 100 patients with ESD for esophageal cancer from January 2018 to October 2020 were selected as the study subjects,followed up by telephone or outpatient review for 1-year postoperative recurrence,Logistic regression equations were used to analyze the factors influencing postoperative recurrence,and R software was used to establish a column line graph model for predicting postoperative recurrence after ESD for esophageal cancer.Results One-year follow-up after operation,6 cases of 100 patients who underwent ESD for esophageal cancer were lost to follow-up,and the recurrence rate was 10.64%;The risk factors of recurrence of esophageal cancer after ESD were lesion diameter≥3.11 cm,SM1 cancer,lesion endoscopy mixed type,intraoperative severe adhesion,preoperative inability to eat and postoperative vascular tumor thrombus(P<0.05);The initial C-index of the nomogram model was 0.876,and the calibration curve showed that the nomogram model had good discrimination and consistency.Conclusion Based on six high-risk factors,including lesion diameter≥3.11 cm,SM1 cancer,mixed type of lesion under endoscopy,severe intraoperative adhesion,preoperative inability to eat and postoperative vascular tumor thrombus,a nomograph model is constructed to predict the recurrence risk of esophageal cancer after ESD,which can accurately identify the recurrence risk after ESD and guide clinical diagnosis and treatment.