内镜黏膜下剥离术治疗早期胃癌适应证扩大的可行性研究。
A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cancer.
机构信息
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
出版信息
Surg Endosc. 2011 Jun;25(6):1985-93. doi: 10.1007/s00464-010-1499-7. Epub 2010 Dec 7.
BACKGROUND
Endoscopic submucosal dissection (ESD) is the standard treatment for selected cases of early gastric cancer (EGC). Evolution of ESD techniques and accessories has expanded treatment indications. The aim of this study was to compare the therapeutic outcomes for conventional and expanded indications of ESD for EGC.
METHODS
Eight hundred six EGC lesions in 780 patients were classified into two groups based on a pathological review: a conventional indication group (595 cases) and an expanded indication group (211 cases). The expanded indication group was classified further into subgroups according to tumor depth and tumor size. Therapeutic outcomes were compared between the conventional and expanded indication groups and between the expanded indication subgroups.
RESULTS
The complete resection rate (97.3% vs. 81.0%, p<0.001) and en bloc complete resection rate (95.6% vs. 79.1%, p=0.003) were higher in the conventional indication group than in the expanded indication group. Among the expanded indication patients, the complete resection rate (64.5% vs. 91.1%, p<0.001) and en bloc complete resection rate (63.2% vs. 89.6%, p<0.001) were lower in the submucosal invasion subgroup than in the mucosal invasion subgroup. The complete resection rate and en bloc complete resection rate did not differ between subgroups classified according to tumor size in the expanded indication group. The conventional indication group and expanded indication group did not differ with regard to the rates of local recurrence (0.7% vs. 0%), metachronous recurrence (3.6% vs. 3.3%), or cumulative disease-free survival. Survival outcome was similar in the subgroups classified by tumor depth and size. Perforation was more frequent in the expanded indication group than in the conventional indication group (6.6% vs. 2.4%, p<0.001).
CONCLUSION
ESD for expanded indication of EGC had acceptable clinical outcomes. ESD can be applied safely to properly selected patients with EGC.
背景
内镜黏膜下剥离术（ESD）是治疗某些早期胃癌（EGC）的标准方法。ESD 技术和器械的发展已经扩大了治疗适应证。本研究旨在比较 EGC 内镜黏膜下剥离术的传统适应证与扩展适应证的治疗效果。
方法
根据病理回顾，将 780 例 806 处 EGC 病变患者分为两组：传统适应证组（595 例）和扩展适应证组（211 例）。进一步根据肿瘤深度和大小将扩展适应证组分为亚组。比较了传统适应证组和扩展适应证组以及扩展适应证亚组之间的治疗效果。
结果
传统适应证组的完全切除率（97.3%比 81.0%，p<0.001）和整块切除率（95.6%比 79.1%，p=0.003）均高于扩展适应证组。在扩展适应证患者中，黏膜下浸润亚组的完全切除率（64.5%比 91.1%，p<0.001）和整块切除率（63.2%比 89.6%，p<0.001）低于黏膜浸润亚组。在扩展适应证组中，根据肿瘤大小分类的亚组之间的完全切除率和整块切除率无差异。传统适应证组和扩展适应证组在局部复发率（0.7%比 0%）、异时复发率（3.6%比 3.3%）或累积无病生存率方面无差异。根据肿瘤深度和大小分类的亚组的生存结果相似。穿孔在扩展适应证组比在传统适应证组更常见（6.6%比 2.4%，p<0.001）。
结论
EGC 的 ESD 扩展适应证具有可接受的临床效果。ESD 可以安全地应用于适当选择的 EGC 患者。
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