胃肠内镜检查对咽鳞状细胞癌早期检测的临床影响：一项回顾性队列研究。
Clinical impact of gastrointestinal endoscopy on the early detection of pharyngeal squamous cell carcinoma: A retrospective cohort study.
作者信息
Miyamoto Hideaki, Naoe Hideaki, Morinaga Jun, Sakisaka Kensuke, Tayama Sayoko, Matsuno Kenshi, Gushima Ryosuke, Tateyama Masakuni, Shono Takashi, Imuta Masanori, Miyamaru Satoru, Murakami Daizo, Orita Yorihisa, Tanaka Yasuhito
机构信息
Department of Gastroenterology and Hepatology, Kumamoto University Hospital, Kumamoto 860-8556, Japan.
Department of Clinical Investigation, Kumamoto University Hospital, Kumamoto 860-8556, Japan.
出版信息
World J Gastrointest Endosc. 2021 Oct 16;13(10):491-501. doi: 10.4253/wjge.v13.i10.491.
BACKGROUND
In recent years, with the growing availability of image-enhanced gastrointestinal endoscopy, gastroenterologists have contributed to the early detection of pharyngeal squamous cell carcinomas (SCC).
AIM
To clarify the clinical characteristics of pharyngeal SCCs detected by gastrointestinal endoscopy.
METHODS
This is a retrospective cohort study conducted in a single-center, a university hospital in Japan. We retrospectively assessed the clinical records of 522 consecutive patients with oropharyngeal or hypopharyngeal SCC who were examined in our hospital between 2011 and 2018. The lesions were classified into two groups: Group GE (detected by gastrointestinal endoscopy) and Group non-GE (detected by means other than gastrointestinal endoscopy). The clinical characteristics were compared between the two groups. Continuous data were compared using the Mann-Whitney test. Pearson's test or Fisher's exact test was used to analyze the categorical data and compare proportions. The Kaplan-Meier method was used to estimate the cumulative patient survival rates.
RESULTS
In our study group, the median age was 65 years and 474 patients (90.8%) were male. One hundred and ninety-six cases (37.5%) involved the oropharynx and 326 cases (62.5%) involved the hypopharynx. Three hundred and ninety-five cases (75.7%) had some symptoms at the time of diagnosis. One hundred and forty-five (27.8%) cases had concurrent ESCC or a history of ESCC. One hundred and sixty-four (31.4%) cases were detected by gastrointestinal endoscopy and classified as Group GE. The proportions of asymptomatic cases, cTis-1 cases and cases with no lymph node metastasis were significantly higher in Group GE than Group non-GE (61.6% 7.3%, < 0.001, 32.9% 12.0%, < 0.001 and 69.5% 19.0%, < 0.001). Endoscopic laryngo-pharyngeal surgery or endoscopic submucosal dissection were performed in only 0.6% of the lesions in Group non-GE but in 21.3% of the lesions in Group GE ( < 0.001). Overall survival was significantly longer in Group GE than in Group non-GE ( = 0.018). The 2-year and 4-year survival rates were 82.5% and 70.7% in Group GE, and 71.5% and 59.0% in Group non-GE, respectively.
CONCLUSION
Gastrointestinal endoscopy plays an important role in the early detection and improving the prognosis of pharyngeal SCCs.
背景
近年来，随着图像增强型胃肠内镜检查的日益普及，胃肠病学家在早期发现咽鳞状细胞癌（SCC）方面发挥了作用。
目的
阐明通过胃肠内镜检查发现的咽SCC的临床特征。
方法
这是一项在日本一家大学医院单中心进行的回顾性队列研究。我们回顾性评估了2011年至2018年期间在我院接受检查的522例连续性口咽或下咽SCC患者的临床记录。病变分为两组：GE组（通过胃肠内镜检查发现）和非GE组（通过胃肠内镜检查以外的方法发现）。比较两组的临床特征。连续数据采用Mann-Whitney检验进行比较。Pearson检验或Fisher精确检验用于分析分类数据并比较比例。采用Kaplan-Meier方法估计患者累积生存率。
结果
在我们的研究组中，中位年龄为65岁，474例患者（90.8%）为男性。196例（37.5%）累及口咽，326例（62.5%）累及下咽。395例（75.7%）在诊断时有一些症状。145例（27.8%）有同时性食管SCC或食管SCC病史。164例（31.4%）通过胃肠内镜检查发现并归类为GE组。GE组无症状病例、cTis-1病例和无淋巴结转移病例的比例显著高于非GE组（61.6%对7.3%，P<0.001；32.9%对12.0%，P<0.001；69.5%对19.0%，P<0.001）。非GE组仅0.6%的病变进行了内镜下咽手术或内镜黏膜下剥离术，而GE组为21.3%（P<0.001）。GE组的总生存期显著长于非GE组（P=0.018）。GE组的2年和4年生存率分别为82.5%和70.7%，非GE组分别为71.5%和59.0%。
结论
胃肠内镜检查在咽SCC的早期发现和改善预后方面发挥着重要作用。
Zotero 插件