Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Faculty of Gastroenterology of Capital Medical University, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, 100050, China.
BMC Gastroenterol. 2022 Apr 20;22(1):194. doi: 10.1186/s12876-022-02273-2.
Delayed bleeding is an important adverse event after gastric endoscopic submucosal dissection (ESD). We aimed to externally validate the Bleeding after ESD Trend from Japan (BEST-J) score and subsequently develop a risk prediction model for bleeding in Chinese patients with early gastric cancer (EGC) after ESD.
The clinical data of patients who underwent ESD for EGC in Beijing Friendship Hospital from June 2013 to December 2019 were collected retrospectively. The BEST-J score was evaluated according to the clinical data. Through univariate and multivariate logistic regression analyses of the clinical data, the factors affecting delayed bleeding were identified, and a new risk prediction model for bleeding was established. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of the two prediction models.
A total of 444 patients with EGC undergoing ESD were included, of whom 27 patients had delayed bleeding (6.1%). Multivariate logistic regression analysis showed that a history of smoking (P = 0.029), tumor size > 20 mm (P = 0.022), intraoperative use of hemoclips (P = 0.025), resection of multiple tumors (P = 0.027), and prolongation of activated partial thromboplastin time (APTT) (P = 0.020) were independent influencing factors for delayed bleeding. ROC curve analysis showed that the areas under the curves (AUCs) were different between the BEST-J score and the newly built prediction model (0.624 vs. 0.749, P = 0.012).
The BEST-J score has moderately good discrimination for Chinese patients with EGC. However, for patients with EGC without severe comorbidities, the new risk prediction model may predict delayed bleeding better than the BEST-J score.
延迟性出血是胃内镜黏膜下剥离术（ESD）后的一个重要不良事件。本研究旨在对日本胃内镜黏膜下剥离术后出血趋势（BEST-J）评分进行外部验证，并在此基础上建立一个适合中国早期胃癌（EGC）患者行 ESD 术后出血的风险预测模型。
回顾性收集 2013 年 6 月至 2019 年 12 月在北京友谊医院行 ESD 治疗的 EGC 患者的临床资料，根据临床资料评估 BEST-J 评分。通过单因素和多因素 logistic 回归分析确定影响延迟性出血的因素，并建立新的出血风险预测模型。采用受试者工作特征（ROC）曲线评估两种预测模型的预测价值。
共纳入 444 例行 ESD 的 EGC 患者，其中 27 例发生延迟性出血（6.1%）。多因素 logistic 回归分析显示，吸烟史（P=0.029）、肿瘤直径＞20mm（P=0.022）、术中使用止血夹（P=0.025）、多发肿瘤切除（P=0.027）和 APTT 延长（P=0.020）是延迟性出血的独立影响因素。ROC 曲线分析显示，BEST-J 评分和新建立的预测模型的曲线下面积（AUC）不同（0.624 比 0.749，P=0.012）。
BEST-J 评分对中国 EGC 患者具有较好的区分度，但对于无严重合并症的 EGC 患者，新的风险预测模型可能比 BEST-J 评分更能预测延迟性出血。
