内镜黏膜下剥离术与外科手术治疗早期食管胃连接部腺癌的倾向性评分匹配分析

Endoscopic Submucosal Dissection versus Surgical Treatment for Early Esophagogastric Junction Adenocarcinoma: Propensity Score Matching Analysis

目的比较ESD与外科手术方法在治疗早期食管胃连接部腺癌(AEG)的临床效果及预后,并分析影响预后的因素。方法收集2010年1月至2022年12月在安徽省立医院接受ESD或者外科手术治疗的早期AEG的住院患者,其中ESD 186人,经外科手术组364人,采用1∶1的倾向性评分匹配,每组164人,比较匹配前后两组临床结局、生存结局及术后并发症。分析影响早期AEG患者死亡及复发的危险因素。结果1.匹配前、后,ESD组均较外科手术组的手术时间、住院时间、住院费用、术中出血量、不良事件低,(P<0.001)。2.匹配前ESD组1,3,5年总生存率分别为:99.5%、94.5%、90.2%,外科手术组1,3,5年生存率分别为100%,99.4%,97.5%。在匹配前ESD组1,3,5年无复发生存率分别为:99.5%、96.3%、93.4%,外科手术组1,3,5年无复发生存率分别为100%、98.6%、92.5%。匹配前后的K-M生存分析显示,两组之间的总生存期、无复发生存期无显著差异(P>0.05)。3.年龄、低分化、脉管浸润是OS的独立危险因素;年龄、肿瘤大小是影响RFS的独立危险因素。结论早期AEG患者接受ESD或外科手术治疗具有一致的临床结局,ESD可以作为治疗早期AEG是一种有效、安全的方式。

Objective To compare the clinical efficacy and prognosis of endoscopic submucosal dissection(ESD)and surgical methods in the treatment of early esophagogastric junction adenocarcinoma(AEG),and to analyze factors influencing prognosis.Methods Hospitalized patients with early AEG who underwent ESD or surgical treatment at Anhui Provincial Hospital from January 2010 to December 2022 were collected.Among them,186 patients underwent ESD and 364 patients underwent surgical treatment.Propensity score matching was used with a ratio of 1∶1,with 164 patients in each group.Clinical outcomes,survival outcomes,and postoperative complications were compared before and after matching.Factors influencing mortality and recurrence in EGJ patients were analyzed.Results 1.Before and after matching,the ESD group had lower surgical time,hospital stay,hospital costs,intraoperative bleeding volume,and adverse events compared to the surgical group(P<0.001).2.The matched ESD group had 1-,3-,and 5-year overall survival rates of 99.5%,94.5%,and 90.2%,respectively,while the surgical group had rates of 100%,99.4%,and 97.5%for the same periods.The 1-,3-,and 5-year recurrence-free survival rates in the matched ESD group were 99.5%,96.3%,and 93.4%,respectively,compared to 100%,98.6%,and 92.5%in the surgical group.Kaplan-Meier survival analysis before and after matching showed no significant difference in overall survival and recurrence-free survival between the two groups(P>0.05).3.Age,poor differentiation,and vascular invasion were independent risk factors for OS;age and tumor size were independent risk factors for RFS.Conclusion Patients with early AEG undergoing ESD or surgical treatment have consistent clinical outcomes.ESD can be considered an effective and safe treatment for early AEG.