Hao Xiao-Wen, Li Peng, Wang Yong-Jun, Ji Ming, Zhang Shu-Tian, Shi Hai-Yun
National Clinical Research Centre for Digestive Disease, Beijing Digestive Disease Centre, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
World J Gastrointest Oncol. 2022 Jul 15;14(7):1337-1347. doi: 10.4251/wjgo.v14.i7.1337.
Colorectal laterally spreading tumors (LSTs) with malignant potential require resection by endoscopic submucosal dissection (ESD), but lesions with deep submucosal invasion (SMI) are endoscopically unresectable.
To investigate the factors associated with high-grade dysplasia (HGD)/carcinoma and deep SMI in colorectal LSTs.
The endoscopic and histological results of consecutive patients who underwent ESD for colorectal LSTs in our hospital from June 2013 to March 2019 were retrospectively analyzed. The characteristics of LST subtypes were compared. Risk factors for HGD/carcinoma and deep SMI (invasion depth ≥ 1000 μm) were determined using multivariate logistic regression.
A total of 323 patients with 341 colorectal LSTs were enrolled. Among the four subtypes, non-granular pseudodepressed (NG-PD) LSTs (85.5%) had the highest rate of HGD/carcinoma, followed by the granular nodular mixed (G-NM) (77.0%), granular homogenous (29.5%), and non-granular flat elevated (24.2%) subtypes. Deep SMI occurred commonly in NG-PD LSTs (12.9%). In the adjusted multivariate analysis, NG-PD [odds ratio (OR) = 16.8, < 0.001) and G-NM (OR = 7.8, < 0.001) subtypes, size ≥ 2 cm (OR = 2.2, = 0.005), and positive non-lifting sign (OR = 3.3, = 0.024) were independently associated with HGD/carcinoma. The NG-PD subtype (OR = 13.3, < 0.001) and rectosigmoid location (OR = 8.7, = 0.007) were independent risk factors for deep SMI.
Because of their increased risk for malignancy, it is highly recommended that NG-PD and G-NM LSTs are removed through ESD. Given their substantial risk for deep SMI, surgery needs to be considered for NG-PD LSTs located in the rectosigmoid, especially those with positive non-lifting signs.
具有恶变潜能的大肠侧向发育型肿瘤（LSTs）需要通过内镜黏膜下剥离术（ESD）切除，但黏膜下深层浸润（SMI）的病变在内镜下无法切除。
探讨大肠LSTs中高级别异型增生（HGD）/癌及黏膜下深层浸润的相关因素。
回顾性分析2013年6月至2019年3月在我院接受ESD治疗的大肠LSTs连续患者的内镜及组织学结果。比较LST亚型的特征。采用多因素logistic回归分析确定HGD/癌及黏膜下深层浸润（浸润深度≥1000μm）的危险因素。
共纳入323例患者的341个大肠LSTs。在四种亚型中，非颗粒状假凹陷型（NG-PD）LSTs（85.5%）的HGD/癌发生率最高，其次是颗粒状结节混合型（G-NM）（77.0%）、颗粒状均匀型（29.5%）和非颗粒状扁平隆起型（24.2%）亚型。黏膜下深层浸润常见于NG-PD LSTs（12.9%）。在调整后的多因素分析中，NG-PD[比值比（OR）=16.8，<0.001]和G-NM（OR=7.8，<0.001）亚型、大小≥2cm（OR=2.2，=0.005）及非抬举征阳性（OR=3.3，=0.024）与HGD/癌独立相关。NG-PD亚型（OR=13.3，<0.001）及直肠乙状结肠部位（OR=8.7，=0.007）是黏膜下深层浸润的独立危险因素。
由于其恶变风险增加，强烈建议通过ESD切除NG-PD和G-NM LSTs。鉴于其黏膜下深层浸润风险较高，对于位于直肠乙状结肠的NG-PD LSTs，尤其是非抬举征阳性者，需要考虑手术治疗。
