Ma Xiaoqian, Zhang Qian, Zhu Shengtao, Zhang Shutian, Sun Xiujing
Department of Gastroenterology and Hepatology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, China.
Front Med (Lausanne). 2021 May 14;8:637875. doi: 10.3389/fmed.2021.637875. eCollection 2021.
EGC, also known as Early Gastric Cancer is known to lack the lymph node metastasis and confined along the mucosa, which is treated through an endoscopic resection procedure that includes ESD (Endoscopic Submucosal dissection) and EMR (Endoscopic Mucosal Resection). However, some cases underwent residual disease, recurrence, or additional gastrectomy because of non-curative resection. The following research aims to delineate the threat factors causing the non-curative resection as well as develop a predictive model. Effort was taken to collect all the records about the health history of pathologically diagnosed EGC who experienced endoscopic treatment in the Department of Endoscopy, the Capital Medical University, and Beijing Friendship Hospital from January 2012 to January 2020. Patients were grouped into two categories primarily; a curative resection group and finally a non-curative resection group based on the outcomes of the postoperative pathological and immunohistochemical examination results. The statistical methods used included single factor analysis, a multivariate logistic regression analysis and a chi-square test. A nomogram for the prediction of non-curative resection was constructed, which included information on age, gender, resection method, postoperative pathology, tumor size, ulcer, treatment, and infiltration depth. Receiver operating characteristic (ROC) curve analysis and calibration were performed to present the predictive accuracy of the nomogram. Of 443 patients with 478 lesions who had undergone ESD or EMR for EGCs, 127 were identified as being treated non-curative resection. Older patients (>60 years), a large tumor size (>30 mm), submucosal lesion, piecemeal resection, EMR for treatment and undifferentiated tumor histology were associated with non-curative resection group. Our risk nomogram showed good discriminated performance in internal validation (bootstrap-corrected area under the receiver-operating characteristic curve, 0.881; < 0.001). A validated prediction model was developed to identify people who were subject to undergoing a non-curative resection for ESD. The predictive model that we formulated is essential in providing reliable information to guide the decision-making process on the treatment for EGC before undertaking an endoscopic resection.
早期胃癌（EGC），也被称为早期胃癌，已知其缺乏淋巴结转移且局限于黏膜层，通过包括内镜黏膜下剥离术（ESD）和内镜黏膜切除术（EMR）在内的内镜切除手术进行治疗。然而，一些病例由于切除不彻底而出现残留病灶、复发或需要再次进行胃切除术。以下研究旨在确定导致切除不彻底的危险因素，并建立一个预测模型。研究人员努力收集了2012年1月至2020年1月期间在首都医科大学附属北京友谊医院内镜科接受内镜治疗的病理诊断为EGC患者的所有健康史记录。患者主要分为两类：根据术后病理和免疫组化检查结果分为根治性切除组和最终的非根治性切除组。所使用的统计方法包括单因素分析、多因素逻辑回归分析和卡方检验。构建了一个用于预测非根治性切除的列线图，其中包括年龄、性别、切除方法、术后病理、肿瘤大小、溃疡、治疗方式和浸润深度等信息。进行了受试者操作特征（ROC）曲线分析和校准，以展示列线图的预测准确性。在443例因EGC接受ESD或EMR治疗的478个病变患者中，有127例被确定为接受了非根治性切除。老年患者（>60岁）、肿瘤较大（>30mm）、黏膜下病变、分片切除、采用EMR治疗以及肿瘤组织学类型为未分化与非根治性切除组相关。我们的风险列线图在内部验证中显示出良好的区分性能（自抽样校正的受试者操作特征曲线下面积，0.881；P<0.001）。开发了一个经过验证的预测模型，以识别可能接受ESD非根治性切除的人群。我们制定的预测模型对于在进行内镜切除之前为EGC治疗决策过程提供可靠信息至关重要。
