异时性继发性原发性恶性肿瘤的发现与卢戈氏不着色病变数量之间的关联。
Association between the findings of metachronous secondary primary malignancies and the number of Lugol-voiding lesions.
作者信息
Katada Chikatoshi, Yokoyama Tetsuji, Yano Tomonori, Oda Ichiro, Shimizu Yuichi, Takemura Kenichi, Koike Tomoyuki, Takizawa Kohei, Hirao Motohiro, Okada Hiroyuki, Nakayama Norisuke, Kubota Yutaro, Matsuo Yasumasa, Kawakubo Hirofumi, Ishikawa Hideki, Yokoyama Akira, Muto Manabu
机构信息
Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan.
Department of Health Promotion, National Institute of Public Health, Wako, Japan.
出版信息
Dis Esophagus. 2020 Sep 4;33(9). doi: 10.1093/dote/doz110.
This study was designed to evaluate the relation between dysplastic squamous epithelium in the esophageal mucosa and the development of metachronous secondary primary malignancies (mSPM) other than esophagus after endoscopic resection (ER) in patients with early esophageal squamous cell carcinoma (SCC). We studied 330 patients with early esophageal SCC who underwent ER as a post hoc analysis of a prospective multicenter cohort study (UMIN Clinical Trials Registry ID UMIN000001676). Lugol-voiding lesions (LVL) were graded into 3 categories (A = no lesion; B = 1 to 9 lesions; C ≥ 10 lesions). The following variables were studied: (i) the incidences of mSPM other than esophagus; (ii) the standardized incidence ratios (SIRs) of mSPM; (iii) the cumulative incidence and total number of mSPM other than esophagus; and (iv) predictors of mSPM other than esophagus on analysis with a multivariate Cox proportional-hazards model. After a median follow-up of 46.6 months, mSPM other than esophagus was diagnosed in a total of 73 patients (90 lesions). Among the 106 patients in group C, 37 patients had mSPM (51 lesions), including head and neck cancer in 14 patients (24 lesions) and gastric cancer in 12 patients (16 lesions). The SIR of mSPM was 3.61 in this study subjects. An increase in the LVL grade (A to B to C) was associated with a progressive increase in the cumulative incidence rate of mSPM other than esophagus (P = 0.017 for A vs. C, P = 0.023 for B vs. C). An increase in the LVL grade (A to B to C) was also associated with a progressive increase in the total number of mSPM other than esophagus per 100 person-years (primary events, relative risk [RR] = 1.66 and 3.24 for grades B and C, respectively, vs. A, P = 0.002 for trend; all events, RR = 1.81 and 4.66 for grades B and C, respectively, vs. A, P < 0.0001 for trend). LVL grade C was a strong predictor of mSPM other than esophagus (RR = 3.41 for A vs. C). LVL grade may be a useful predictor of the risk of mSPM other than esophagus after ER in patients with early esophageal SCC.
本研究旨在评估早期食管鳞状细胞癌（SCC）患者内镜切除（ER）后食管黏膜发育异常的鳞状上皮与食管以外异时性继发原发性恶性肿瘤（mSPM）发生之间的关系。我们对330例接受ER的早期食管SCC患者进行了研究，这是一项前瞻性多中心队列研究（UMIN临床试验注册编号UMIN000001676）的事后分析。不着色病变（LVL）分为3类（A =无病变；B = 1至9个病变；C≥10个病变）。研究了以下变量：（i）食管以外mSPM的发生率；（ii）mSPM的标准化发病比（SIR）；（iii）食管以外mSPM的累积发病率和总数；（iv）使用多变量Cox比例风险模型分析时食管以外mSPM的预测因素。中位随访46.6个月后，共73例患者（90个病变）被诊断为食管以外的mSPM。在C组的106例患者中，37例患者发生了mSPM（51个病变），其中14例患者（24个病变）为头颈癌，12例患者（16个病变）为胃癌。本研究对象中mSPM的SIR为3.61。LVL分级升高（从A到B再到C）与食管以外mSPM的累积发病率逐渐增加相关（A组与C组比较，P = 0.017；B组与C组比较，P = 0.023）。LVL分级升高（从A到B再到C）还与每100人年食管以外mSPM的总数逐渐增加相关（原发事件，B级和C级相对于A级的相对风险[RR]分别为1.66和3.24，趋势P = 0.002；所有事件，B级和C级相对于A级的RR分别为1.81和4.66，趋势P <0.0001）。LVL C级是食管以外mSPM的有力预测因素（A级与C级比较，RR = 3.41）。LVL分级可能是早期食管SCC患者ER后食管以外mSPM风险的有用预测指标。
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