直径小于2厘米的胃黏膜下病变的长期预后及肿瘤生长的危险因素
Long-Term Outcomes of Gastric Subepithelial Lesion of < 2 cm and Risk Factors for Tumor Growth.
作者信息
Iwasaki Miyuki, Matsumura Tomoaki, Okimoto Kenichiro, Ohyama Yuhei, Mamiya Yukiyo, Nakazawa Hayato, Takahashi Satsuki, Horio Ryosuke, Goto Chihiro, Sonoda Michiko, Kurosugi Akane, Kaneko Tatsuya, Ohta Yuki, Taida Takashi, Matsusaka Keisuke, Ozawa Yoshihito, Hayano Koichi, Kato Jun, Matsubara Hisahiro, Kato Naoya
机构信息
Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan.
出版信息
J Gastroenterol Hepatol. 2025 Aug;40(8):1926-1932. doi: 10.1111/jgh.17019. Epub 2025 May 23.
BACKGROUND AND AIM
Endoscopic resection of small gastric subepithelial lesions (SELs) has been recently reported. However, evidence of natural history of untreated small gastric SELs is lacking. This study aimed to investigate the long-term course of gastric SELs of < 2 cm as well as identify the enlargement rate and factors affecting it.
METHODS
A total of 1045 gastric SELs in 1033 patients were evaluated via endoscopic ultrasonography (EUS) from January 1994 to December 2023. Of these, this study included 125 SELs in 122 patients with an initial tumor diameter of < 2 cm and who underwent at least two EUS examinations. Tumor diameter was measured through EUS and considered enlarged when the longitudinal diameter increased > 1.25 times from the initial size. Multivariate Cox proportional hazards regression analysis was used to identify factors affecting tumor enlargement.
RESULTS
The average observation period was 4.0 ± 3.4 years. A total of 29 (23.2%) lesions were enlarged during the observation period, with a mean tumor doubling time of 4.1 ± 3.8 years and an augmentation rate of 5.7/100 person-years. The multivariate analysis indicated that the initial tumor size of ≥ 9.5 mm (hazard ratio [HR]: 3.99, 95% confidence interval [CI]: 1.33-11.94) and EUS finding changes (irregular border, cystic space, high echoic lesion, and/or heterogeneity), excluding calcifications (HR: 2.55, 95% CI: 1.09-5.97), were increasing factors.
CONCLUSIONS
The augmentation rate of gastric SELs of < 2 cm was 5.7/100 person-years. These results provide valuable data for treatment decisions.
背景与目的
近期有报道称可通过内镜切除胃小上皮下病变（SELs）。然而，目前缺乏未经治疗的胃小SELs自然病程的相关证据。本研究旨在调查直径＜2 cm的胃SELs的长期病程，并确定其增大率及相关影响因素。
方法
1994年1月至2023年12月期间，通过内镜超声检查（EUS）对1033例患者的1045个胃SELs进行了评估。其中，本研究纳入了122例患者的125个初始肿瘤直径＜2 cm且至少接受过两次EUS检查的SELs。通过EUS测量肿瘤直径，当纵向直径较初始大小增加＞1.25倍时视为增大。采用多因素Cox比例风险回归分析确定影响肿瘤增大的因素。
结果
平均观察期为4.0±3.4年。在观察期内，共有29个（23.2%）病变增大，平均肿瘤倍增时间为4.1±3.8年，年增长率为5.7/100人年。多因素分析表明，初始肿瘤大小≥9.5 mm（风险比[HR]：3.99，95%置信区间[CI]：1.33 - 11.94）以及EUS表现改变（边界不规则、囊性间隙、高回声病变和/或不均匀性，不包括钙化）（HR：2.55，95% CI：1.09 - 5.97）是肿瘤增大的相关因素。
结论
直径＜2 cm的胃SELs的年增长率为5.7/100人年。这些结果为治疗决策提供了有价值的数据。
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