摘要
目的:探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期胃癌术后复发相关危险因素。方法:选取2012年01月至2018年06月在我院消化内科接受ESD治疗的206例早期胃癌患者的临床病历资料进行回顾性分析。根据术后复发情况将患者分为复发组和无复发组。比较两组患者临床资料;绘制Kaplan-Meier生存曲线评估早期胃癌术后复发情况;患者术后复发的独立危险因素采用多因素Cox比例风险回归模型分析。结果:ESD治疗的206例早期胃癌患者中,31例病情复发,复发率为15.05%,1年、3年、5年无复发率分别为91.75%、87.38%、84.95%;复发组和无复发组患者镜下分型、病变大小、病理分化程度、浸润深度、手术切缘性质比较差异有统计学意义(P<0.05);多因素Cox回归分析显示:病变大小、病理分化程度、浸润深度、手术切缘性质均是影响ESD治疗的早期胃癌患者术后复发的独立危险因素(P<0.05)。结论:病变越大、病理分化程度越低、肿瘤浸润深度达黏膜下层、手术切缘阳性是ESD治疗的早期胃癌患者术后复发的独立危险因素,对于存在危险因素患者应加强术后监测。
Objective:To explore the risk factors of recurrence after endoscopic submucosal dissection(ESD)for early gastric cancer.Methods:The clinical data of 206 patients with early gastric cancer who received ESD treatment in the gastroenterology department in our hospital from January 2012 to June 2018 were analyzed retrospectively.According to the postoperative recurrence,the patients were divided into recurrence group and non recurrence group.The clinical data were compared between the two groups.Kaplan-Meier survival curve was drawn to evaluate the recurrence of early gastric cancer.The independent risk factors of postoperative recurrence were analyzed by multivariate Cox proportional risk regression model.Results:Among 206 cases of early gastric cancer treated by ESD,31 cases had relapse,and the recurrence rate was 15.05%.The recurrence free rate was 91.75%,87.38% and 84.95% respectively in one year,three years and five years.There were significant differences in microscopical classification,lesion size,pathological differentiation degree,depth of invasion,nature of surgical margin between the recurrence group and non recurrence group(P<0.05).The Cox risk review model showed that the size of lesions,pathological differentiation degree,depth of invasion,and the nature of surgical margin were all independent risk factors for postoperative recurrence in patients with early stage gastric cancer treated by ESD(P<0.05).Conclusion:The larger the lesion,the lower the degree of pathological differentiation,the depth of tumor invasion to the submucosa,and the positive surgical margin are the independent risk factors of postoperative recurrence in patients with early stage gastric cancer treated by ESD.Patients with risk factors should be monitored intensifiedly after operation.
作者
习晓丽
叶美玲
王禾
XI Xiaoli;YE Meiling;WANG He(Department of Digestive,the First People's Hospital in Yibin,Sichuan Yibin 644000,China)
出处
《现代肿瘤医学》
CAS
北大核心
2022年第7期1264-1268,共5页
Journal of Modern Oncology
关键词
内镜黏膜下剥离术
早期胃癌
复发
endoscopic submucosal dissection
early gastric cancer
recurrence
