Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Dig Dis Sci. 2021 Feb;66(2):612-618. doi: 10.1007/s10620-020-06194-6. Epub 2020 Mar 17.
Size, ulcer, differentiation, and location are known to be factors affecting the T stage accuracy of EUS in gastric cancer. However, whether an interaction exists among recognized variables is poorly understood. The aim of this study was to identify the combinatorial characteristics of group with high overestimation rate to determine which group should be considered carefully for EUS-based treatment plans.
We retrospectively analyzed early gastric cancer patients who underwent EUS from 2005 to 2016. The accuracy of EUS T stage and factors affecting over-/underestimation were examined by using decision tree analysis, the CHAID method.
The most significant factor affecting the accuracy of the EUS T stage was the size. The rate of overestimation was higher in lesions > 3 cm (37.2% vs. 28.8% vs. 17.1%, p < 0.001). In lesions > 3 cm, the rate of overestimation was higher in lesions with an ulcer (62.1% vs. 35.0%, p < 0.001). Moreover, for lesions ≤ 3 cm, the accuracy of the EUS T stage was more affected by differentiation and location. The rate of overestimation was higher in undifferentiated-type lesions ≤ 2 cm (24.5% vs. 13.9%, p < 0.001) and 2-3 cm (33.3% vs. 25.7%, p = 0.011). In the differentiated type, the location affected the accuracy of the EUS T stage.
In this hierarchical analysis, the rate of overestimation was higher in lesions > 3 cm with ulcer, lesions > 3 cm irrespective of ulcer, and undifferentiated-type lesions measuring 2-3 cm.
大小、溃疡、分化和位置是影响胃癌 EUS T 分期准确性的已知因素。然而，这些公认的变量之间是否存在相互作用尚不清楚。本研究的目的是确定具有高高估率的组合特征，以确定哪些组应仔细考虑基于 EUS 的治疗计划。
我们回顾性分析了 2005 年至 2016 年间接受 EUS 的早期胃癌患者。通过决策树分析、CHAID 方法检查 EUS T 分期的准确性及其影响因素。
影响 EUS T 分期准确性的最重要因素是大小。病变>3cm 的高估率较高（37.2%比 28.8%比 17.1%，p<0.001）。在病变>3cm 中，有溃疡的病变高估率更高（62.1%比 35.0%，p<0.001）。此外，对于病变≤3cm，EUS T 分期的准确性受分化和位置的影响更大。分化差的病变≤2cm（24.5%比 13.9%，p<0.001）和 2-3cm（33.3%比 25.7%，p=0.011）高估率更高。在分化型中，位置影响 EUS T 分期的准确性。
在这个分层分析中，病变>3cm 且有溃疡、病变>3cm 且不论有无溃疡、分化差且大小为 2-3cm 的病变高估率更高。
