Shi Hong-Peng, Wu Wei, Zhang Ben-Yan, Beeharry Maneesh-Kumarsing, Feng Tie-Nan, Zhu Zheng-Gang, Yuan Fei, Zhu Zheng-Lun
Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
Wideochir Inne Tech Maloinwazyjne. 2021 Mar;16(1):45-53. doi: 10.5114/wiitm.2020.94270. Epub 2020 Apr 7.
Gastric cancer (GC) is a common malignant tumor with a high mortality rate.
To determine the accuracy of preoperative imaging information obtained from the combined use of general gastroscopy (GS), endoscopic ultrasonography (EUS), and multi-detector computed tomography (MDCT) regarding absolute indication of endoscopic submucosal dissection (ESD) in early gastric cancer (EGC).
The relationship between clinical features of 794 EGC patients and lymph node metastasis (LNM) was analyzed. Multivariate logistic regression analysis was used to investigate the risk factors for LNM. Additionally, the accuracy of diagnosis of imaging techniques for ESD indications was determined by receiver operating characteristic (ROC) analysis.
Data showed that tumor size > 2 cm (p = 0.0071), T1b stage (p < 0.0001), undifferentiated histology (p < 0.0001), and vascular invasion (p = 0.0007) were independent risk factors for LNM in patients with EGC. Indications for ESD have a specificity of 100% for the diagnosis of patients with LNM. Additionally, the diagnostic efficacy of the use of GS, EUS, and MDCT in identifying node positive status, T1a disease, tumor size ≤ 2 cm, and ulceration was found to be moderate with area under the curve (AUC) of receiver operating characteristic curve (ROC) of 0.71, 0.64, 0.72, and 0.68, respectively. Furthermore, the use of imaging techniques for overall indication criteria for ESD had a moderate utility value with an AUC of 0.71.
Our data suggested that, based on the combined use of GS, EUS, and MDCT, a high specificity of patient selection for ESD treatment can be achieved.
胃癌（GC）是一种常见的恶性肿瘤，死亡率很高。
确定联合使用普通胃镜检查（GS）、内镜超声检查（EUS）和多排螺旋计算机断层扫描（MDCT）获得的术前影像信息对于早期胃癌（EGC）内镜黏膜下剥离术（ESD）绝对指征的准确性。
分析794例EGC患者的临床特征与淋巴结转移（LNM）之间的关系。采用多因素logistic回归分析探讨LNM的危险因素。此外，通过受试者工作特征（ROC）分析确定影像技术对ESD指征的诊断准确性。
数据显示，肿瘤大小>2 cm（p = 0.0071）、T1b期（p < 0.0001）、未分化组织学类型（p < 0.0001）和血管侵犯（p = 0.0007）是EGC患者LNM的独立危险因素。ESD指征对LNM患者的诊断特异性为100%。此外，发现使用GS、EUS和MDCT识别淋巴结阳性状态、T1a期疾病、肿瘤大小≤2 cm和溃疡的诊断效能中等，受试者工作特征曲线（ROC）的曲线下面积（AUC）分别为0.71、0.64、0.72和0.68。此外，使用影像技术评估ESD总体指征标准的实用价值中等，AUC为0.71。
我们的数据表明，基于GS、EUS和MDCT的联合使用，可以实现ESD治疗患者选择的高特异性。
