摘要
目的探讨组织学分型为混合型的早期胃癌临床病理特征,同时分析内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期胃癌的预后。方法收集2011年1月至2020年3月在甘肃省武威肿瘤医院行ESD治疗的早期胃癌患者的临床资料,采用描述性统计方法分析混合型早期胃癌患者临床病理特征,采用logistic回归模型分析ESD治疗早期胃癌的临床效果及影响因素,采用Kaplan-Meier方法估计生存率,log-rank检验进行生存率的比较。结果本研究共纳入269例患者(280个病灶),其中男216例(80.30%),女53例(19.70%),年龄为(60.43±8.01)岁;混合型早期胃癌病灶25个(8.93%),分化型早期胃癌248个(88.57%),未分化型早期胃癌7个(2.50%)。相较于分化型和未分化型,混合型早期胃癌的病变部位以胃上1/3为主[64.00%(16/25)、40.73%(101/248)比0.00%(0/7),χ^(2)=10.211,P=0.006],病变大小≤2 cm占比较小[52.00%(13/25)、80.65%(200/248)比85.71%(6/7),χ^(2)=11.173,P=0.004],浸润深度黏膜内较少[52.00%(13/25)、85.48%(212/248)比57.14%(4/7),χ^(2)=20.019,P<0.001],垂直切缘阳性比例相对较高[20.00%(5/25)、2.82%(7/248)比0.00%(0/7),χ^(2)=16.657,P<0.001],侵犯脉管比例高于分化型癌低于未分化型癌[36.00%(9/25)、2.42%(6/248)比42.86%(3/7),χ^(2)=58.413,P<0.001],完全切除率较低[76.00%(19/25)、93.15%(231/248)比100.00%(7/7),χ^(2)=9.497,P=0.009],治愈性切除率低于分化型早期胃癌但高于未分化型早期胃癌[48.00%(12/25)、89.52%(222/248)比42.86%(3/7),χ^(2)=39.757,P<0.001],eCura C2级比例高于分化型癌低于未分化型癌[48.00%(12/25)、5.65%(14/248)比57.14%(4/7),χ^(2)=58.766,P<0.001]。多因素分析结果显示,病变越大(P=0.004,OR=0.539,95%CI:0.354~0.822)为治愈性切除的危险因素;相较于黏膜下深层浸润,浸润至黏膜层(P=0.001,OR=51.799,95%CI:5.535~84.768)和黏膜下浅层(P<0.001,OR=29.301,95%CI:24.694~73.972)是治愈性切除的保护因素;相对于混合型早期胃癌,分化型早期�
ObjectiveTo investigate the clinicopathological characteristics of early gastric cancer with mixed histological staging,and to analyze the prognostic effect of endoscopic submucosal dissection(ESD)for early gastric cancer.MethodsClinical data of early gastric cancer patients treated with ESD in Gansu Wuwei Cancer Hospital from January 2011 to March 2020 were collected,and clinicopathological characteristics of patients with mixed-type early gastric cancer were analyzed by descriptive statistical methods.The clinical effects and influencing factors of ESD on early gastric cancer were analyzed by logistic regression.Kaplan-Meier was used to estimate the survival rate,and log-rank test was used to compare the survival rate.ResultsA total of 269 patients(280 lesions)were included in this study,including 216 males(80.30%)and 53 females(19.70%),with age of 60.43±8.01 years.There were 25 lesions(8.93%)of mixed early gastric cancer,248 lesions(88.57%)of differentiated early gastric cancer,and 7 lesions(2.50%)of undifferentiated early gastric cancer.Compared with differentiated and undifferentiated early gastric cancer,the lesion site of mixed early gastric cancer was mainly located in the upper 1/3 of the stomach[64.00%(16/25),40.73%(101/248)VS 0.00%(0/7),χ^(2)=10.211,P=0.006],the proportion of the lesion size≤2 cm was relatively small[52.00%(13/25),80.65%(200/248)VS 85.71%(6/7),χ^(2)=11.173,P=0.004],and the proportion of infiltration depth in the mucosa was lower[52.00%(13/25),85.48%(212/248)VS 57.14%(4/7),χ^(2)=20.019,P<0.001],the proportion of positive vertical resection margin was relatively high[20.00%(5/25),2.82%(7/248)VS 0.00%(0/7),χ^(2)=16.657,P<0.001],the proportion of vascular invasion was higher than that of differentiated carcinoma but lower than that of undifferentiated carcinoma[36.00%(9/25),2.42%(6/248)VS 42.86%(3/7),χ^(2)=58.413,P<0.001],the complete resection rate was lower[76.00%(19/25),93.15%(231/248)VS 100.00%(7/7),χ^(2)=9.497,P=0.009],the curative resection rate was lower than that of differ
作者
卢林芝
聂蓬
张志鎰
秦天燕
李世华
辛亮
边玉龙
赵光源
刘金殿
Lu Linzhi;Nie Peng;Zhang Zhiyi;Qin Tianyan;Li Shihua;Xin Liang;Bian Yulong;Zhao Guangyuan;Liu Jindian(Department of Gastroenterology,Gansu Wuwei Cancer Hospital,Wuwei 733000,China)
出处
《中华消化内镜杂志》
CSCD
北大核心
2024年第2期104-110,共7页
Chinese Journal of Digestive Endoscopy
基金
国家重点研发计划(2017YFC0908302)
武威市自然科学基金(22JR5RH1035)
武威市市级科技计划项目(WW23B02SF037)。
关键词
胃肿瘤
早期胃癌
混合型
内镜黏膜下剥离术
预后
Gastric neoplasms
Early gastric cancer
Mixed type
Endoscopic submucosal dissection
Prognosis
