Ohara Yoshiko, Toshikuni Nobuyuki, Matsueda Kazuhiro, Mouri Hirokazu, Yamamoto Hiroshi
Department of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University Hospital, Kobe, Japan.
Department of Hepatology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa, 920-029, Japan.
Surg Endosc. 2016 Nov;30(11):4880-4888. doi: 10.1007/s00464-016-4825-x. Epub 2016 Mar 2.
The expanded criteria for endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) have led to an increase in the number of EGC patients who receive curative treatment involving endoscopic techniques. Identifying the factors that are associated with treatment outcomes would be helpful in the application of ESD for EGC.
Potential factors associated with incomplete ESD and with non-curative ESD were investigated using a multiple logistic regression model in EGC patients who consecutively underwent ESD according to the expanded criteria.
A total of 363 patients with 398 EGC lesions were enrolled. The rates of complete ESD and curative ESD were 96.2 % (383/398) and 85.7 % (341/398), respectively. No significant factors associated with incomplete ESD were identified. In contrast, a tumor size >20 mm [odds ratio (OR) 3.31; 95 % confidence interval (CI) 1.74-6.29], the superficial elevated and depressed type (0-IIa + IIc or IIc + IIa) (OR 4.37; 95 % CI 1.88-9.88), and the undifferentiated type (OR 5.93; 95 % CI 1.65-19.41) were identified as independent factors associated with non-curative ESD. The superficial elevated and depressed type in particular was found to be highly related to submucosal and lymphovascular invasion. The rate of non-curative ESD in cases of this macroscopic type occurring together with a tumor size >20 mm was 58.3 %, and the adjusted OR was 16.48 (95 % CI 4.69-62.09).
The results suggest that the superficial elevated and depressed type is an independent factor associated with non-curative ESD and that the risk of non-curative ESD is increased when this macroscopic type is present along with a large tumor size.
早期胃癌（EGC）内镜下黏膜剥离术（ESD）标准的扩大，使得接受内镜治疗的EGC患者数量增加。确定与治疗结果相关的因素将有助于ESD在EGC中的应用。
在根据扩大标准连续接受ESD的EGC患者中，使用多因素logistic回归模型研究与ESD不完全及非治愈性ESD相关的潜在因素。
共纳入363例患者的398个EGC病变。ESD完全切除率和治愈性ESD率分别为96.2%（383/398）和85.7%（341/398）。未发现与ESD不完全相关的显著因素。相比之下，肿瘤大小>20mm[比值比（OR）3.31；95%置信区间（CI）1.74 - 6.29]、浅表隆起凹陷型（0-IIa + IIc或IIc + IIa）（OR 4.37；95%CI 1.88 - 9.88）和未分化型（OR 5.93；95%CI 1.65 - 19.41）被确定为与非治愈性ESD相关的独立因素。特别是浅表隆起凹陷型被发现与黏膜下层和淋巴管侵犯高度相关。这种宏观类型与肿瘤大小>20mm同时出现时，非治愈性ESD率为58.3%，调整后的OR为16.48（95%CI 4.69 - 62.09）。
结果表明，浅表隆起凹陷型是与非治愈性ESD相关的独立因素，当这种宏观类型与大肿瘤大小同时存在时，非治愈性ESD的风险增加。
