侵袭性凹陷模式、大结节和凹陷是西方人群结直肠侧向扩散肿瘤黏膜下浸润的预测因素。

Invasive pit pattern, macronodule and depression are predictive factors of submucosal invasion in colorectal laterally spreading tumours from a Western population.

作者信息

Soliman Heithem, Brieau Bertrand, Guillaumot Marie-Anne, Leblanc Sarah, Barret Maximilien, Camus Marine, Dior Marie, Terris Benoit, Coriat Romain, Prat Frédéric, Chaussade Stanislas

机构信息

Gastroenterology and Endoscopy Department, Cochin Teaching Hospital, Assistance Publique Hopitaux de Paris (APHP), Paris, France.

INSERM U1016 - Institut Cochin, Paris-Descartes University, Paris-France.

出版信息

United European Gastroenterol J. 2018 Dec;6(10):1569-1577. doi: 10.1177/2050640618804713. Epub 2018 Oct 5.

DOI:10.1177/2050640618804713

PMID:30574328

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6297923/

Abstract

BACKGROUND

Laterally spreading tumours are separated in subclasses: granular, homogenous or nodular mixed; and non-granular, flat or pseudodepressed. For every subtype, a proper risk of submucosal invasive cancer has been described in Asian series.

OBJECTIVE

The aim of the study was to determine the rate of cancer and submucosal invasive cancer in a Western series of endoscopic-resected laterally spreading tumours and their endoscopic predictive factors.

METHODS

A total of 374 laterally spreading tumours ≥20 mm were resected by endoscopy in our single centre between 2012-2016. We analysed endoscopic and pathological data from our prospective database, determining the rates of cancer and submucosal invasive cancer according to the subtype of laterally spreading tumour.

RESULTS

The rates of submucosal invasive cancer for granular homogenous, granular nodular mixed, non-granular flat, non-granular pseudodepressed laterally spreading tumours were 4.9%, 15.9%, 3.0% and 19.4%, respectively. Endoscopic mucosal resection was used in 58.0% and endoscopic submucosal dissection in 42.0%. Endoscopic submucosal dissection was associated with a higher rate of en-bloc resection (87.3% vs 26.3%; < 0.0001), and a lower risk of recurrence (7.6% vs 15.2%; = 0.026). Adverse event rates were not statistically different (9.5% vs 6.4%, = 0.26). Predictive endoscopic factors of submucosal invasive cancer were: invasive pit pattern (hazard ratio = 33 (8.81-143.3)), non-granular pseudodepressed laterally spreading tumours (hazard ratio = 11.9 (0.89-146.2)), and granular nodular mixed laterally spreading tumours (hazard ratio = 3.42 (0.99-13.0)).

CONCLUSIONS

The risk of submucosal invasive cancer varies according to the laterally spreading tumour subtype. Three factors were associated with submucosal invasion and should justify an endoscopic submucosal dissection: non-granular pseudodepressed laterally spreading tumours, granular nodular mixed laterally spreading tumours subtypes and invasive pit pattern.

摘要

背景

侧向扩散性肿瘤可分为以下亚类：颗粒状、均质型或结节状混合型；以及非颗粒状、扁平型或假凹陷型。在亚洲的研究系列中，已描述了每种亚型发生黏膜下浸润癌的适当风险。

目的

本研究的目的是确定西方系列内镜切除的侧向扩散性肿瘤中癌和黏膜下浸润癌的发生率及其内镜预测因素。

方法

2012年至2016年期间，我们单中心共通过内镜切除了374例直径≥20mm的侧向扩散性肿瘤。我们分析了前瞻性数据库中的内镜和病理数据，根据侧向扩散性肿瘤的亚型确定癌和黏膜下浸润癌的发生率。

结果

颗粒状均质型、颗粒状结节状混合型、非颗粒状扁平型、非颗粒状假凹陷型侧向扩散性肿瘤的黏膜下浸润癌发生率分别为4.9%、15.9%、3.0%和19.4%。58.0%的病例采用内镜黏膜切除术，42.0%采用内镜黏膜下剥离术。内镜黏膜下剥离术与整块切除率较高相关（87.3%对26.3%；<0.0001），复发风险较低（7.6%对15.2%；=0.026）。不良事件发生率无统计学差异（9.