牙龈卟啉单胞菌预测早期食管鳞癌或癌前病变内镜黏膜下剥离术后局部复发。
Porphyromonas gingivalis predicts local recurrence after endoscopic submucosal dissection of early esophageal squamous cell carcinoma or precancerous lesion.
机构信息
State Key Laboratory of Esophageal Cancer Prevention & Treatment, Henan Key Laboratory of Microbiome and Esophageal Cancer Prevention and Treatment, Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, 471003, Luoyang, China.
Endoscopy Center, Zhongshan Hospital of Fudan University, 200032, Shanghai, China.
出版信息
BMC Cancer. 2023 Jan 13;23(1):43. doi: 10.1186/s12885-022-10469-8.
BACKGROUND
Porphyromonas gingivalis plays an oncogenic role in development and progression of esophageal squamous cell carcinoma (ESCC). However, the impact of P. gingivalis on local recurrence of early ESCC or precancerous lesion after ESD treatment remains unknown. The present study aimed to evaluate the impact of P. gingivalis on local recurrence after ESD treatment of early ESCC or high-grade dysplasia (HGD).
METHODS
The amount of P. gingivalis was assessed by immunohistochemistry in 205 patients with early ESCC or HGD. Univariate and multivariate Cox regression analyses were performed to determine the effect of P. gingivalis on local recurrence. Propensity score matching analysis was performed to reduce the imbalance of baseline characteristics. A nomogram integrating significant prognostic factors was built for local recurrence prediction.
RESULTS
The amount of P. gingivalis increased significantly in neoplasms that invaded up to muscularis mucosa and submucosa compared with lesions confined to epithelium or lamina propria. Overabundance of P. gingivalis was positively associated with invasion depth, post-ESD stricture and local recurrence. Univariate and multivariate Cox regression analyses revealed that P. gingivalis, longitudinal length of lesion and lymphovascular invasion were independent predictors for post-ESD recurrence. A nomogram comprising P. gingivalis, lymphovascular involvement, and lesion length performed well for prediction of post-ESD local recurrence with the concordance indices of 0.72 (95%CI, 0.62 to 0.80), 0.72 (95%CI, 0.63 to 0.80), and 0.74 (95%CI, 0.65 to 0.83) in the validation cohort, the entire cohort, and the subcohort after PSM, respectively.
CONCLUSION
P. gingivalis overabundance is a risk factor and a potential predictor for local recurrence of early ESCC or HGD after ESD treatment. Thus, clearance of P. gingivalis represents an attractive strategy for prognosis improvement and for prevention of ESCC.
背景
牙龈卟啉单胞菌在食管鳞状细胞癌（ESCC）的发展和进展中具有致癌作用。然而，牙龈卟啉单胞菌对 ESD 治疗后早期 ESCC 或癌前病变局部复发的影响尚不清楚。本研究旨在评估牙龈卟啉单胞菌对早期 ESCC 或高级别上皮内瘤变（HGD）行 ESD 治疗后局部复发的影响。
方法
通过免疫组织化学法检测 205 例早期 ESCC 或 HGD 患者中牙龈卟啉单胞菌的含量。采用单因素和多因素 Cox 回归分析确定牙龈卟啉单胞菌对局部复发的影响。采用倾向评分匹配分析来减少基线特征的不平衡。构建一个整合显著预后因素的列线图来预测局部复发。
结果
与局限于上皮或固有层的病变相比，侵犯至黏膜肌层和黏膜下层的肿瘤中牙龈卟啉单胞菌的含量显著增加。牙龈卟啉单胞菌过度增殖与浸润深度、ESD 后狭窄和局部复发呈正相关。单因素和多因素 Cox 回归分析显示，牙龈卟啉单胞菌、病变的纵向长度和脉管侵犯是 ESD 后复发的独立预测因子。一个包含牙龈卟啉单胞菌、脉管侵犯和病变长度的列线图在验证队列、整个队列和 PSM 后亚队列中对 ESD 后局部复发的预测具有良好的一致性指数，分别为 0.72（95%CI，0.62 至 0.80）、0.72（95%CI，0.63 至 0.80）和 0.74（95%CI，0.65 至 0.83）。
结论
牙龈卟啉单胞菌过度增殖是 ESD 治疗后早期 ESCC 或 HGD 局部复发的危险因素和潜在预测因子。因此，清除牙龈卟啉单胞菌可能是改善预后和预防 ESCC 的一种有吸引力的策略。
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