同时性多发与单发早期胃癌临床病理特征比较以及多发癌病灶关联性分析  

Comparison of Clinicopathological Features Between Synchronous Multiple and Solitary Early Gastric Cancer and Relevance of Major and Minor Lesions of Synchronous Multiple Cancers

作　　者：李荣雪 张倩 孙秀静 邢洁 朱圣韬 李鹏 张澍田 LI Rongxue;ZHANG Qian;SUN Xiujing;XING Jie;ZHU Shengtao;LI Peng;ZHANG Shutian(Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing Digestive Disease Center,Faculty of Gastroenterology of Capital Medical University,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases,Beijing,100050)

机构地区：[1]首都医科大学附属北京友谊医院消化内科国家消化系统疾病临床医学研究中心北京市消化疾病中心首都医科大学消化病学系消化疾病癌前病变北京市重点实验室

出　　处：《胃肠病学》2019年第8期454-459,共6页Chinese Journal of Gastroenterology

基　　金：国家重点研发计划项目(2017YFC1700601);国家自然科学基金(81802310);北京市医院管理局消化内科学科协同发展中心重点项目(XXZ0103)

摘　　要：背景:早期胃癌检出率不断提高,但同时性多发早期胃癌(SMEGC)漏诊率较高,提高SMEGC的内镜诊断和治疗水平具有重要意义。目的:探讨SMEGC的临床病理特征及其主、次病灶间的关联性。方法:回顾性连续收集2013年6月—2018年12月于北京友谊医院行内镜黏膜下剥离术(ESD)的231例早期胃癌病例,比较单发早期胃癌(SEGC)与SMEGC的临床、内镜病理特征和治疗效果,分析SMEGC主、次病灶内镜病理特征的关联性。结果:231例早期胃癌病例中16例(6.9%)为SMEGC(34处病灶)。SEGC与SMEGC在性别、年龄、消化道肿瘤家族史,以及病灶大小、垂直方向分布、分化程度、侵犯深度、背景黏膜方面均无明显差异(P>0.05)。在水平方向分布和大体形态方面,SMEGC出现于胃体后壁(38.2%)和隆起型(47.1%)比例更高(P<0.05),且均为分化型癌。SMEGC主、次病灶的大体形态(r=0.658)和分化程度(r=0.489)具有显著相关性(P<0.05),主、次病灶大体形态、分化程度、侵犯深度相同的SMEGC分别占68.8%、81.2%和87.5%,主、次病灶背景黏膜均一致。SEGC和SMEGC的治愈性切除率无明显差异(86.0%对85.3%,P>0.05)。结论:SMEGC的临床病理特征与SEGC相似,主、次病灶的大体形态、分化程度、侵犯深度和背景黏膜具有一致性,ESD为其有效治疗方式。Background:The detection rate of early gastric cancer has been increasing over recent decades,but synchronous multiple early gastric cancer(SMEGC)remains a challenge for endoscopists.It is important to improve the endoscopic diagnosis and treatment of SMEGC.Aims:To investigate the clinicopathological features of SMEGC and the correlation of its major and minor lesions.Methods:The medical records of 231 consecutive early gastric cancer patients treated by endoscopic submucosal dissection(ESD)in Beijing Friendship Hospital from Jun.2013 to Dec.2018 were retrospectively analyzed for comparing the clinical,endoscopic,pathological features and treatment outcome between solitary early gastric cancer(SEGC)and SMEGC.The relevance of major and minor lesions of SMEGC in endoscopic and pathological features was also analyzed.Results:Of the 231 early gastric cancer patients,16(6.9%)were SMEGC(34 lesions).The gender,age,and family history of GI tumors were comparable between SEGC and SMEGC(P>0.05).Furthermore,lesions of these two groups did not differ in tumor size,vertical location,histological differentiation,depth of invasion,and mucosal background(P>0.05).With respect to horizontal location and macroscopic type,SMEGC lesions were more often located in posterior wall(38.2%)and presented as elevated type(47.1%)as compared with SEGC lesions(P<0.05).All SMEGC lesions were differentiated type.The major and minor lesions of SMEGC were correlated in characteristics of macroscopic type(r=0.658,P<0.05)and histological differentiation(r=0.489,P<0.05),the concordance rates of these two aspects and depth of invasion were 68.8%,81.2%,and 87.5%,respectively.The mucosal background of major and minor lesions was identical.The curative resection rates were comparable between SEGC and SMEGC(86.0%vs.85.3%,P>0.05).Conclusions:SMEGC and SEGC have similar clinicopathological features.The major and minor lesions of SMEGC are consistent in characteristics of macroscopic type,histological differentiation,depth of invasion,and mucosal background.E

关 键 词：胃肿瘤 肿瘤 多原发性 早期胃癌 内镜黏膜下剥离术 临床病理特征 

分 类 号：R73[医药卫生—肿瘤]