G1期和G2期胃神经内分泌肿瘤的内镜联合血清学诊断策略及内镜下治疗疗效分析

Therapeutic efficacy analysis of endoscopic combined with serological diagnosis strategy and endoscopic in G1 and G2 gastric neuroendocrine neoplasms

目的探讨G1、G2期胃神经内分泌肿瘤(G-NENs)内镜联合血清学诊断策略,评价内镜下黏膜切除术(EMR)和内镜下黏膜剥离术(ESD)的安全性及治疗疗效。方法回顾性分析中国医学科学院肿瘤医院2011年1月至2023年10月住院行内镜下治疗的全部连续100例G-NENs患者的临床资料,比较倾向性评分匹配(PSM)前后EMR组与ESD组病灶的临床病理特征及治疗疗效。结果100例G-NENs患者,中位年龄54岁。29例术前完善了内镜联合血清学检查,其中血浆嗜铬粒蛋白A异常升高24例(82.8%)。内镜联合血清学诊断策略对自身免疫性萎缩性胃炎的诊断准确率可达到100.0%(22/22)。共纳入G-NENs病灶235个,ESD组84个,EMR组151个。ESD组病灶中位长径(5.0 mm,范围0.4~15.0 mm)大于EMR组(2.0 mm,范围0.1~15.0 mm;P<0.001),ESD组病理分级为G2(23.8%,20/84)、浸润深度达黏膜下层(78.6%,66/84)、T分期为T2期(15.5%,13/84)的病变也均多于EMR组[分别为1.3%(2/151)、51.0%(77/151)和0.7%(1/151),均P<0.001]。经过PSM两组成功匹配了49对病灶。PSM后,ESD组和EMR组的整块切除率[分别为100.0%(49/49)和100.0%(49/49)]、完整切除率[分别为93.9%(46/49)和100.0%(49/49)]和并发症发生率[分别为0(0/49)和4.1%(2/49)]差异均无统计学意义(均P>0.05)。ESD组和EMR组所有病灶均未发现切除原部位的复发及远处转移。结论内镜联合血清学诊断策略可以提高对G1、G2期G-NENs及其背景黏膜的诊断准确率。内镜下切除手术(EMR和ESD)对于G1、G2期G-NENs来说是一种安全、有效的治疗方式。

Objective To investigate the endoscopic combined serological diagnosis strategy for G1 and G2 gastric neuroendocrine neoplasms(G-NENs),and to evaluate the safety,short-term,and long-term efficacy of two endoscopic treatment procedures:endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD).Methods This study retrospectively analyzed the clinical data of 100 consecutive patients with G-NENs who were hospitalized at the Cancer Hospital of the Chinese Academy of Medical Sciences from January 2011 to October 2023.These patients underwent endoscopic treatment,and propensity score matching(PSM)was used to compare clinicopathological characteristics,as well as short-term and long-term efficacy of lesions in the EMR group and ESD group before and after treatment.Results Among the 100 patients with G-NENs,the median age was 54 years old.Before surgery,29 cases underwent endoscopic combined serological examination,and 24 of them(82.2%)had abnormally elevated plasma chromogranin A.The combined diagnostic strategy for autoimmune atrophic gastritis(AIG)achieved a diagnostic accuracy of 100%(22/22).A total of 235 G-NEN lesions were included,with 84 in the ESD group and 151 in the EMR group.The median size of the lesions in the ESD group(5.0 mm)was significantly larger than that in the EMR group(2.0 mm,P<0.001).Additionally,the ESD group had significantly more lesions with pathological grade G2[23.8%(20/84)vs.1.3%(2/151),P<0.001],infiltration depth reaching the submucosal layer[78.6%(66/84)vs.51.0%(77/151),P<0.001],and more T2 stage compared to the EMR group[15.5%(13/84)vs.0.7%(1/151),P<0.001].After PSM,49 pairs of lesions were successfully matched between the two groups.Following PSM,there were no significant differences in the en bloc resection rate[100.0%(49/49)vs.100.0%(49/49)],complete resection rate[93.9%(46/49)vs.100.0%(49/49)],and complication rate[0(0/49)vs.4.1%(2/49)]between the two groups.During the follow-up period,no recurrence or distant metastasis was observed in any of the lesions in both groups.Conclusions The combination of endoscopy and serology diagnostic strategy has the potential to enhance the accuracy of diagnosing G1 and G2 stage G-NENs and their background mucosa.Endoscopic resection surgery(EMR,ESD)is a proven and safe treatment approach for G1 and G2 stage G-NENs.