不同分化程度的早期胃肿瘤的特征及内镜黏膜下剥离术长期预后的预测因素。
Characteristics of early gastric tumors with different differentiation and predictors of long-term outcomes after endoscopic submucosal dissection.
机构信息
Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China.
Department of Pathology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China.
出版信息
World J Gastroenterol. 2024 Apr 14;30(14):1990-2005. doi: 10.3748/wjg.v30.i14.1990.
BACKGROUND
Gastric cancer is a common malignant tumor of the digestive tract, and endoscopic submucosal dissection (ESD) is the preferred treatment for early-stage gastric cancer. The analysis of the epidemiological characteristics of gastric mucosal tumors with different differentiation degrees and the influencing factors of long-term ESD efficacy may have certain significance for revealing the development of gastric cancer and ESD.
AIM
To analyze the features of gastric mucosal tumors at different differentiation levels, and to explore the prognostic factors of ESD.
METHODS
We retrospectively studied 301 lesions in 285 patients at The Second Affiliated Hospital of Xi'an Jiaotong University from 2014 to 2021, according to the latest Japanese guidelines (sixth edition), and divided them into low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN), and differentiated and undifferentiated early carcinoma. They are followed up by endoscopy, chest and abdominal computed tomography at 3, 6 and 12 months after ESD. We compared clinicopathologic characteristics, ESD efficacy, and complications with different degrees of differentiation, and analyzed the related factors associated with ESD.
RESULTS
HGIN and differentiated carcinoma patients were significantly older compared with LGIN patients ( < 0.001) and accounted for more 0-IIc ( < 0.001), atrophic gastritis was common ( < 0.001), and irregular microvascular patterns (IMVPs) and demarcation lines (DLs) were more obvious ( < 0.001). There was more infiltration in the undifferentiated carcinoma tissue ( < 0.001), more abnormal folds and poorer mucosal peristalsis ( < 0.001), and more obvious IMVPs, irregular microsurface patterns and DLs ( < 0.05) than in the LGIN and HGIN tissues. The disease-free survival rates at 2, 5, and 8 years after ESD were 95.0%, 90.1%, and 86.9%, respectively. Undifferentiated lesions (HR 5.066), white moss (HR 7.187), incomplete resection (HR 3.658), and multiple primary cancers (HR 2.462) were significantly associated with poor prognosis.
CONCLUSION
Differentiations of gastric mucosal tumors have different epidemiological and endoscopic characteristics, which are closely related to the safety and efficacy of ESD.
背景
胃癌是一种常见的消化道恶性肿瘤，内镜黏膜下剥离术（ESD）是治疗早期胃癌的首选方法。分析不同分化程度的胃黏膜肿瘤的流行病学特征及 ESD 长期疗效的影响因素，可能对揭示胃癌及 ESD 的发生发展具有一定意义。
目的
分析胃黏膜肿瘤不同分化程度的特征，并探讨 ESD 的预后因素。
方法
回顾性分析 2014 年至 2021 年西安交通大学第二附属医院 285 例 301 处病灶，根据最新日本指南（第六版）将其分为低级别上皮内瘤变（LGIN）、高级别上皮内瘤变（HGIN）和分化型及未分化型早期癌，ESD 后 3、6、12 个月行内镜及胸腹部 CT 随访。比较不同分化程度患者的临床病理特征、ESD 疗效及并发症，分析与 ESD 相关的影响因素。
结果
HGIN 及分化型癌患者较 LGIN 患者年龄更大（<0.001），且更多为 0-IIc 型（<0.001），萎缩性胃炎更为常见（<0.001），且不规则微血管形态（IMVP）和边界线（DL）更为明显（<0.001）。未分化型癌组织浸润更深（<0.001），黏膜皱襞不规则及蠕动欠佳更多见（<0.001），且 IMVP、不规则微表面形态及 DL 更为明显（<0.05）。ESD 后 2、5、8 年无病生存率分别为 95.0%、90.1%、86.9%。未分化病变（HR 5.066）、白苔（HR 7.187）、不完全切除（HR 3.658）和多发原发性癌（HR 2.462）与预后不良显著相关。
结论
胃黏膜肿瘤的分化程度具有不同的流行病学和内镜特征，与 ESD 的安全性和疗效密切相关。
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