Kobayashi Kiyonori, Tanaka Shinji, Murakami Yoshitaka, Ishikawa Hideki, Sada Miwa, Oka Shiro, Saito Yutaka, Iishi Hiroyasu, Kudo Shin-Ei, Ikematsu Hiroaki, Igarashi Masahiro, Saitoh Yusuke, Inoue Yuji, Hisabe Takashi, Tsuruta Osamu, Sano Yasushi, Yamano Hiroo, Shimizu Seiji, Yahagi Naohisa, Matsuda Keiji, Nakamura Hisashi, Fujii Takahiro, Sugihara Kenichi
Research and Development Center for New Medical Frontiers Kitasato University School of Medicine Kanagawa Japan.
Department of Endoscopy Hiroshima University Hospital Hiroshima Japan.
JGH Open. 2019 Jul 16;4(1):83-89. doi: 10.1002/jgh3.12222. eCollection 2020 Feb.
Although colorectal laterally spreading tumors (LSTs) can be classified into four subtypes, the histopathological characteristics are known to differ among these subtypes. We therefore performed a logistic regression analysis to determine whether the risk of pathological T1 cancer of large colorectal LSTs can be predicted based on factors such as endoscopic findings in a large group of patients enrolled in a multicenter study in Japan.
In the main study, we assessed 1236 colorectal adenomas or early cancers that were classified as LSTs measuring 20 mm or more in diameter and treated endoscopically. Logistic regression analysis was performed to determine whether factors such as the subtype of LST could be used to predict the risk of pathological T1 cancer. A validation study of 356 large colorectal LSTs was conducted to confirm the validity of the results obtained in the main study.
The locations and tumor diameter of the LSTs in the main study were found to differ significantly according to the LST subclassification ( < 0.001). The frequency of pathological T1 cancers was the highest at 36% of LST nongranular pseudodepressed type, followed by 14% of LST nongranular flat-elevated type, 11% of LST granular nodular mixed type, and 3% of LST granular homogenous type lesions. The risk of pathological T1 cancer was significantly associated with LST subclassification and tumor diameter. The area under the curve (AUC) was high (0.743). In the validation study, the AUC was 0.573.
In patients with large colorectal LSTs resected endoscopically, the risk of pathological T1 cancer can be predicted on the basis of the LST subclassification and tumor diameter.
尽管大肠侧向发育型肿瘤（LSTs）可分为四种亚型，但已知这些亚型的组织病理学特征有所不同。因此，我们进行了一项逻辑回归分析，以确定在日本一项多中心研究纳入的一大组患者中，能否根据内镜检查结果等因素预测大肠大型LSTs发生病理T1期癌的风险。
在主要研究中，我们评估了1236例被分类为直径20毫米或更大的LSTs并接受内镜治疗的大肠腺瘤或早期癌。进行逻辑回归分析以确定LST亚型等因素是否可用于预测病理T1期癌的风险。对356例大肠大型LSTs进行了验证研究，以确认主要研究结果的有效性。
主要研究中LSTs的位置和肿瘤直径根据LST亚分类存在显著差异（<0.001）。病理T1期癌的发生率在LST非颗粒型假凹陷型中最高，为36%，其次是LST非颗粒型扁平隆起型中的14%、LST颗粒型结节混合型中的11%以及LST颗粒型均质型病变中的3%。病理T1期癌的风险与LST亚分类和肿瘤直径显著相关。曲线下面积（AUC）较高（0.743）。在验证研究中，AUC为0.573。
在内镜切除的大肠大型LSTs患者中，可根据LST亚分类和肿瘤直径预测病理T1期癌的风险。
