黏膜多环套扎切除术治疗早期胃癌术后复发的危险因素

Efficacy of multi-band mucosectomy on early gastric cancer and risk factors of postoperative recurrence

目的:探讨黏膜多环套扎切除术(MBM)治疗早期胃癌(GC)术后复发的危险因素。方法:选取78例行MBM治疗的早期GC患者为研究对象,根据术后是否复发分为复发组(n=20)和未复发组(n=58)。比较两组患者的临床资料,分析影响MBM治疗早期GC术后复发的因素及其对术后复发的预测价值。结果:78例患者中,术后治愈率为74.36%(58/78),复发率为25.64%(20/78)。两组患者病变部位、肿瘤大小、浸润深度、切缘状态及术前血清癌胚抗原(CEA)、癌抗原19-9(CA19-9)和甲胎蛋白(AFP)水平比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,肿瘤大小、浸润深度、切缘状态及术前血清CEA、CA19-9和AFP水平均为MBM治疗早期GC术后复发的危险因素(P<0.05)。ROC曲线分析显示,肿瘤大小、浸润深度、切缘状态及术前血清CEA、CA19-9和AFP水平预测MBM治疗早期GC术后复发的曲线下面积(AUC)分别为0.643、0.763、0.714、0.809、0.853、0.843(P<0.05);各危险因素联合预测的AUC为0.982,敏感度为0.90,特异度为0.95(P<0.05)。结论:在早期GC治疗中,MBM显示出较高的疗效;肿瘤大小、浸润深度、切缘状态及血清中的CEA、CA19-9和AFP水平是术后复发的关键影响因素。

Objective:To analyze the efficacy of multi-band mucosectomy(MBM)in the treatment of early gastric cancer(GC)and the risk factors of postoperative recurrence.Methods:A total of 78 patients with early GC in the hospital were selected as the research subjects.The patients were divided into recurrence group(n=20)and non-recurrence group(n=58)according to whether the recurrence occurred after surgery.The clinical data of the patients were compared,and the factors affecting early GC postoperative recurrence in MBM treatment and their predictive value for postoperative recurrence were analyzed.Results:Among the 78 patients,the postoperative cure rate was 74.36%(58/78),and the recurrence rate was 25.64%(20/78).There were significant differences in lesion location,tumor size,depth of invasion,incisal margin status,preoperative serum carcinoembryonic antigen(CEA),cancer antigen 19-9(CA19-9)and alpha-fetoprotein(AFP)between the recurrence group and the non-recurrence group(P<0.05).Multivariate Logistic regression analysis suggested that tumor size,depth of invasion,incisal margin status and preoperative serum CEA,CA19-9 and AFP were risk factors for postoperative recurrence in patients with early GC(P<0.05).ROC curve analysis showed that the AUC s of tumor size,depth of invasion,incisal margin status and preoperative serum CEA,CA19-9 and AFP in predicting postoperative recurrence of early GC patients were 0.643,0.763,0.714,0.809,0.853 and 0.843,respectively(P<0.05).The AUC of the combination of risk factors was 0.982,with a sensitivity of 0.90 and a specificity of 0.95(P<0.05).Conclusion:MBM shows high efficacy in early GC treatment.Tumor size,depth of invasion,incisal margin status,and serum CEA,CA19-9 and AFP levels are all key influencing factors for postoperative recurrence.