Yan Bin-Bin, Cheng Li-Na, Yang Hui, Li Xiu-Ling, Wang Xiu-Qi
Department of Gastroenterology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou 450000, Henan Province, China.
World J Gastroenterol. 2024 Dec 21;30(47):5007-5017. doi: 10.3748/wjg.v30.i47.5007.
Submucosal invasion in early-stage gastric cancer (GC) is a critical determinant of prognosis and treatment strategy, significantly influencing the risk of lymph node metastasis and recurrence. Identifying risk factors associated with submucosal invasion is essential for optimizing patient management and improving outcomes.
To comprehensively analyze clinical, imaging, and endoscopic characteristics to identify predictors of submucosal invasion in patients with early-stage differentiated GC.
A retrospective study was conducted at our institution from January 2019 to January 2023, including 268 patients diagnosed with early-stage differentiated GC who underwent surgical resection or endoscopic submucosal dissection. Data were collected on demographic, clinical, imaging, and endoscopic characteristics, with endoscopic images reviewed independently by two gastroenterologists. Statistical analysis included univariate and multivariate logistic regression to identify significant predictors of submucosal invasion, and receiver operating characteristic (ROC) curve analysis to evaluate the predictive value of continuous variables.
A total of 268 patients were included, with 178 males and 90 females, and a mean age of 61.5 ± 9.8 years. Univariate analysis showed that male gender, history of alcohol consumption, smoking, and computed tomography-detected gastric wall thickening were more prevalent in patients with submucosal invasion. Significant endoscopic predictors included tumor location in the upper two-thirds of the stomach, depressed morphology, marginal elevation, and high color differences on white-light endoscopy (WLE) and linked color imaging (LCI). Multivariate analysis identified upper stomach location [odds ratio (OR): 5.268], depressed type (OR: 5.841), marginal elevation (OR: 4.132), and LCI color difference ≥ 18.1 (OR: 4.479) as significant predictors. ROC analysis showed moderate predictive value for lesion diameter, WLE, and LCI color differences (area under the curve: 0.630, 0.799, and 0.760, respectively).
Depressed-type lesions, marginal elevation, location in the upper two-thirds of the stomach, and significant color differences on LCI are high-risk indicators for submucosal invasion. These findings suggest that such lesions warrant more aggressive intervention to prevent disease progression and improve patient outcomes.
早期胃癌（GC）的黏膜下浸润是预后和治疗策略的关键决定因素，对淋巴结转移和复发风险有显著影响。识别与黏膜下浸润相关的危险因素对于优化患者管理和改善治疗结果至关重要。
全面分析临床、影像学和内镜特征，以确定早期分化型GC患者黏膜下浸润的预测因素。
2019年1月至2023年1月在我院进行了一项回顾性研究，纳入268例诊断为早期分化型GC并接受手术切除或内镜黏膜下剥离术的患者。收集了人口统计学、临床、影像学和内镜特征数据，内镜图像由两名胃肠病学家独立审查。统计分析包括单因素和多因素逻辑回归，以确定黏膜下浸润的显著预测因素，并进行受试者工作特征（ROC）曲线分析，以评估连续变量的预测价值。
共纳入268例患者，其中男性178例，女性90例，平均年龄61.5±9.8岁。单因素分析显示，男性、饮酒史、吸烟史以及计算机断层扫描检测到的胃壁增厚在黏膜下浸润患者中更为常见。重要的内镜预测因素包括肿瘤位于胃上三分之二、凹陷形态、边缘隆起以及白光内镜（WLE）和联动成像（LCI）上的高颜色差异。多因素分析确定胃上部位置[比值比（OR）：5.268]、凹陷型（OR：5.841）、边缘隆起（OR：4.132）和LCI颜色差异≥18.1（OR：4.479）为显著预测因素。ROC分析显示病变直径、WLE和LCI颜色差异具有中等预测价值（曲线下面积分别为：0.630、0.799和0.760）。
凹陷型病变、边缘隆起、位于胃上三分之二以及LCI上的显著颜色差异是黏膜下浸润的高危指标。这些发现表明，此类病变需要更积极的干预措施，以预防疾病进展并改善患者预后。
