Shi Wen-Jie, Han Jian-Bo, Cheng Gong-Ming, Liu Xu-Cheng, Tao Xue-Wen, Shan Liu-Qun
Department of General Surgery, The Second Hospital of Nanjing, Nanjing 210000, Jiangsu Province, China.
World J Gastrointest Surg. 2025 Aug 27;17(8):107230. doi: 10.4240/wjgs.v17.i8.107230.
To observe the endoscopic and pathological characteristics of laterally spreading tumors (LSTs) and explore the risk factors for carcinogenesis and submucosal infiltration.
To analyze the clinicopathological features of colorectal LSTs treated endoscopically and determine risk factors associated with carcinogenesis and submucosal invasion, providing evidence-based guidance for optimal treatment strategy selection.
This study retrospectively analyzed the sex, age, and endoscopic and pathological features of patients who underwent endoscopic treatment for colorectal LSTs in our hospital from January 2021 to July 2024. Single-factor analysis was used to identify the risk factors for cancer and submucosal infiltration, and the factors with statistical significance were included in multivariate logistic regression analysis.
A total of 422 patients, including 224 males and 198 females, aged 63.45 ± 9.23 years, were included. There were 456 LST lesions in total. The length of the endoscopically resected specimens was 3.01 ± 0.48 cm, and the length of the lesions was 2.37 ± 1.59 cm. It was located in 115 rectums (25.2%), 40 sigmoid colon (8.8%), 26 descending colon (5.7%), 109 transverse colon (23.9%), 112 ascending colon (24.6%), and 54 ileocecal regions (11.8%). Endoscopic submucosal dissection (ESD) was performed in 237 patients (52.0%), and endoscopic mucosal resection (EMR) was performed in 95 patients (20.8%). There were 113 EMR with precutting cases (24.8%), 11 ESD with snare cases (2.4%), 4 delayed bleeding cases and 5 intraoperative perforations. The pathological results revealed 119 cases of low-grade intraepithelial neoplasia (26.1%), 221 cases of high-grade intraepithelial neoplasia (48.5%), 82 cases of intramucosal carcinoma (18.0%), and 34 cases of submucous invasive carcinoma (7.5%). Multiple logistic regression analyses revealed that lesion size ( > 2 cm), lesion location (rectal) and endoscopic classification [false depressed tubulovillous adenoma (LST-NG pseudodepressed type, LST-NG-PD), type 1 particles (LST-G homogenous type), and LST-G nodular mixed type], accompanied by large nodules (with) were independent risk factors for carcinogenesis; endoscopic classification (LST-NG-PD) and the presence of large nodules were independent risk factors for submucosal infiltration.
These risk factors provide practical guidance for treatment selection: LST-NG-PD with large nodules should prioritize ESD, while high-risk rectal lesions > 2 cm may require additional imaging evaluation before endoscopic resection.
观察侧向发育型肿瘤（LSTs）的内镜及病理特征，探讨其癌变及黏膜下浸润的危险因素。
分析经内镜治疗的大肠LSTs的临床病理特征，确定与癌变及黏膜下浸润相关的危险因素，为优化治疗策略选择提供循证指导。
本研究回顾性分析了2021年1月至2024年7月在我院接受大肠LSTs内镜治疗患者的性别、年龄、内镜及病理特征。采用单因素分析确定癌症及黏膜下浸润的危险因素，将具有统计学意义的因素纳入多因素logistic回归分析。
共纳入422例患者，其中男性224例，女性198例，年龄63.45±9.23岁。共有456个LST病变。内镜切除标本长度为3.01±0.48cm，病变长度为2.37±1.59cm。病变位于直肠115例（25.2%）、乙状结肠40例（8.8%）、降结肠26例（5.7%）、横结肠109例（23.9%）、升结肠112例（24.6%）、回盲部54例（11.8%）。237例（52.0%）患者行内镜黏膜下剥离术（ESD），95例（20.8%）患者行内镜黏膜切除术（EMR）。有113例EMR预切开病例（24.8%）、11例ESD圈套器病例（2.4%）、4例迟发性出血病例和5例术中穿孔病例。病理结果显示低级别上皮内瘤变119例（26.1%）、高级别上皮内瘤变221例（48.5%）、黏膜内癌82例（18.0%）、黏膜下浸润癌34例（7.5%）。多因素logistic回归分析显示，病变大小（>2cm）、病变部位（直肠）及内镜分类[假凹陷性管状绒毛状腺瘤（LST-NG假凹陷型，LST-NG-PD）、1型颗粒状（LST-G均质型）及LST-G结节混合型]，伴有大结节（有）是癌变的独立危险因素；内镜分类（LST-NG-PD）及大结节的存在是黏膜下浸润的独立危险因素。
这些危险因素为治疗选择提供了实践指导：有大结节的LST-NG-PD应优先选择ESD，而>2cm的高危直肠病变在内镜切除前可能需要额外的影像学评估。
