Xu Ping, Wang Yun, Dang Yini, Huang Qin, Wang Jianhua, Zhang Weifeng, Zhang Yifeng, Zhang Guoxin
Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.
Department of Gastroenterology, Yancheng City No.1 People's Hospital, Yancheng, Jiangsu, People's Republic of China.
Cancer Manag Res. 2020 Sep 4;12:8037-8046. doi: 10.2147/CMAR.S263525. eCollection 2020.
Non-curative resection (NCR) remains problematic in some cases of early gastric carcinomas (EGCs) treated by endoscopic submucosal dissection (ESD). The aim of this study was to identify predictors of NCR, especially of eCura C1 and eCura C2 resections, before ESD and study long-term outcomes of EGC patients with NCR.
A retrospective review of medical records was conducted over an 8-year period for EGCs undergoing ESD. Clinicopathologic and endoscopic characteristics and patients' survival were analyzed. Risk factors for NCR and eCura C1 and C2 resections were assessed by logistic analyses. Survival of patients was estimated with the Kaplan-Meier method with a Log rank test.
A total of 463 patients with 472 lesions were qualified. By univariate and multivariate analyses, the predictors for NCR and eCura C2 resections were tumor size >20 mm, tumors located in cardia-fundus, uneven surface, margin elevation, and mixed and undifferentiated types, and those for eCura C1 resection were tumors located in cardia-fundus, negative lifting sign, and mixed and undifferentiated types. The 5-year cancer-specific and cancer-free survival rates were 100.0% and 94.2%, and 95.3% and 83.4% in the curative resection (CR) and NCR groups, respectively. The 5-year cancer-specific and cancer-free survival rates were significantly greater in the CR group than that in the NCR group ( <0.0001).
In this cohort, we identified various endoscopic and pathologic features of EGCs to predict NCR, especially eCura C1 and eCura C2 resections before ESD. These clinically valuable factors would be very informative to endoscopists and surgeons who perform ESD to resect EGCs.
在某些接受内镜黏膜下剥离术（ESD）治疗的早期胃癌（EGC）病例中，非根治性切除（NCR）仍然存在问题。本研究的目的是在ESD前确定NCR的预测因素，尤其是eCura C1和eCura C2切除的预测因素，并研究NCR的EGC患者的长期结局。
对8年间接受ESD治疗的EGC患者的病历进行回顾性分析。分析临床病理和内镜特征以及患者的生存率。通过逻辑分析评估NCR以及eCura C1和C2切除的危险因素。采用Kaplan-Meier法和对数秩检验估计患者的生存率。
共有463例患者的472个病灶符合条件。通过单因素和多因素分析，NCR和eCura C2切除的预测因素为肿瘤大小>20mm、位于贲门-胃底的肿瘤、表面不平、边缘隆起以及混合型和未分化型，而eCura C1切除的预测因素为位于贲门-胃底的肿瘤、阴性抬举征以及混合型和未分化型。根治性切除（CR）组和NCR组的5年癌症特异性生存率和无癌生存率分别为100.0%和94.2%，以及95.3%和83.4%。CR组的5年癌症特异性生存率和无癌生存率显著高于NCR组（<0.0001）。
在本队列中，我们确定了EGC的各种内镜和病理特征以预测NCR，尤其是ESD前的eCura C1和eCura C2切除。这些具有临床价值的因素对于进行ESD切除EGC的内镜医师和外科医生非常有参考价值。
