ESD与EMR治疗早期胃癌的疗效及安全性分析

Analysis of the efficacy and safety of ESD and EMR in the treatment of early gastric cancer

目的观察内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)及内镜下黏膜切除术(endoscopic mucosal resection,EMR)治疗早期胃癌对血清肿瘤标志物表达的影响,及不同术式与不良预后发生率的相关性。方法回顾性分析2020年5月至2021年4月南阳医学高等专科学校第一附属医院收治的110例早期胃癌患者为研究对象,根据治疗方式不同,将采用ESD治疗的60例患者列为ESD组[男35例、女25例,年龄(50.33±5.31)岁],采用EMR治疗的50例患者列为EMR组[男30例、女20例,年龄(51.25±5.17)岁]。对比两组患者治疗情况及预后情况,并经Spearman相关性系数检验不同治疗方式与早期胃癌不良预后发生率的相关性。计量资料采用t检验,计数资料采用χ^(2)检验。结果ESD组病灶完整切除率[91.67%(55/60)]、治愈性切除率[83.33%(50/60)]均高于EMR组[70.00%(35/50)、60.00%(30/50)],非治愈性切除率[8.33%(5/60)]低于EMR组[30.00%(15/50)],差异均有统计学意义(χ^(2)=15.156、9.630、15.156,均P<0.05)。术前,两组患者血清肿瘤标志物比较,差异均无统计学意义(均P>0.05);术后,ESD组癌胚抗原(carcinoembryonic antigen,CEA)[(6.41±2.11)μg/L]、糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)[(37.22±5.18)U/ml]、糖类抗原724(carbohydrate antigen 724,CA724)[(35.12±5.47)U/ml]均低于EMR组[(8.24±3.13)μg/L、(40.16±5.33)U/ml、(38.44±5.63)U/ml],差异均有统计学意义(t=3.644、2.925、3.128,均P<0.05)。ESD组术后1年病情复发率为10.00%(6/60)、病死率为6.67%(4/60),均低于EMR组[24.00%(12/50)、18.00%(9/50)],术后2年病情复发率为16.67%(10/60)、病死率为11.67%(7/60),均低于EMR组[32.00%(16/50)、24.00%(12/50)],差异均有统计学意义(χ^(2)=6.945、5.936、6.382、5.187,均P<0.05)。经Spearman相关性系数检验,ESD与早期胃癌不良预后发生率呈负相关(r=-0.155、-0.147,均P<0.001),EMR与早期胃癌不良预后发生率呈正相关(r=0.254、0.251,均P<0.001)。结论与EMR相比,对早期胃癌实施ESD治疗能显著提升病灶切除率,对下调肿瘤标志物表达有重要意义,选择ESD治疗还可有效改善患者预后,降低病情复发及死亡风险。

Objective To observe the effects of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR)on the expression of serum tumor markers in early gastric cancer,and the correlation between different surgical procedures and the incidence of adverse prognosis.Methods This study conducted a retrospective analysis on 110 patients with early gastric cancer admitted to the First Affiliated Hospital of Nanyang Medical College from May 2020 to April 2021.According to different treatment methods,60 patients who underwent ESD surgery were classified as the ESD group[35 males and 25 females,aged(50.33±5.31)years],and 50 patients who underwent EMR surgery were classified as the EMR group[30 males and 20 females,aged(51.25±5.17)years].The treatment and prognosis of the two groups were compared.The correlation between different treatment methods and the incidence of adverse prognosis in early gastric cancer was tested by Spearman correlation coefficient.t test was used for the measurement data and χ^(2) test was used for the count data.Results Under different surgical protocols,the complete resection rate[91.67%(55/60)]and curative resection rate[83.33%(50/60)]of lesions in the ESD group were higher than those in the EMR group[70.00%(35/50)and 60.00%(30/50)],and the non-curative resection rate[8.33%(5/60)]was lower than that in the EMR group[30.00%(15/50)],with statistically significant differences(χ^(2)=15.156,9.630,and 15.156;all P<0.05).Before surgery,there were no statistically significant differences in the serum tumor markers between the two groups(all P>0.05).After surgery,the levels of carcinoembryonic antigen(CEA)[(6.41±2.11)μg/L],carbohydrate antigen 19-9(CA19-9)[(37.22±5.18)U/ml],carbohydrate antigen 724(CA724)[(35.12±5.47)U/ml]in the ESD group were lower than those in the EMR group[(8.24±3.13)μg/L,(40.16±5.33)U/ml,and(38.44±5.63)U/ml],with statistically significant differences(t=3.644,2.925,and 3.128;all P<0.05).The postoperative 1-year recurrence rate and mortality rate of the ESD group were 10.00%(6/60)and 6.67%(4/60),which were both lower than those of the EMR group[24.00%(12/50)and 18.00%(9/50)],and the postoperative 2-year recurrence rate and mortality rate were 16.67%(10/60)and 11.67%(7/60),which were both lower than those of the EMR group[32.00%(16/50)and 24.00%(12/50)],with statistically significant differences(χ^(2)=6.945,5.936,6.382,and 5.187;all P<0.05).According to Spearman correlation coefficient test,ESD surgery was negatively correlated with the incidence of adverse prognosis in early gastric cancer(r=-0.155 and-0.147,both P<0.001),while EMR surgery was positively correlated with the incidence of adverse prognosis in early gastric cancer(r=0.254 and 0.251,both P<0.001).Conclusions Compared with EMR surgery,ESD surgery for early gastric cancer can significantly improve the lesion resection rate and downregulate the expression of tumor markers.Choosing ESD surgery can also effectively improve the prognosis,and reduce the risk of disease recurrence and death.