早期胃癌非治愈性内镜黏膜下剥离术后的治疗策略研究  

The therapeutic strategy after noncurative endoscopic submucosal dissection for early gastric cancer

作　　者：周红 郭春光 陈应泰 窦利州 张月明 王贵齐 赵东兵 Zhou Hong;Guo Chunguang;Chen Yingtai;Dou Lizhou;Zhang Yuemin;Wang Guiqi;Zhao Dongbing(Department of Pancreatic and Gastric Surgical Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Endoscopy,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心国家肿瘤临床医学研究中心中国医学科学院北京协和医学院肿瘤医院胰胃外科,100021 [2]国家癌症中心国家肿瘤临床医学研究中心中国医学科学院北京协和医学院肿瘤医院腔镜科,100021

出　　处：《中华肿瘤杂志》2019年第11期865-869,共5页Chinese Journal of Oncology

摘　　要：目的 探讨早期胃癌患者非治愈性内镜黏膜下剥离术(ESD)切除后的治疗策略.方法 将107例非治愈性ESD治疗的早期胃癌患者,根据ESD术后是否追加外科手术,分为追加手术组(41例)和随访组(66例),比较两组患者的临床病理特征、短期及长期疗效.结果 追加手术组和随访组患者的年龄分别为(59.2±8.7)岁和(64.7±8.8)岁,浸润黏膜下层(SM)深度分别为(1445.83±803.12)和(794.71±815.79) μm,两组差异均有统计学意义(P=0.020,P=0.010).与随访组比较,追加手术组的未分化型、SM2浸润、Lauren分型弥漫型较多,脉管瘤栓和神经侵犯更多见,差异均有统计学意义(均P<0.05).追加手术组ESD手术的R0切除率为26.8%,低于随访组(65.2%,P<0.001).追加手术组ESD术后肿瘤残留率为31.7%(13/41),淋巴结转移率为9.8%(4/41).追加手术组和随访组分别有2例和5例出现肿瘤复发,复发率分别为4.9%和7.6%,差异无统计学意义(P=0.883).追加手术组和随访组的总生存率和无病生存率差异无统计学意义(P=0.066,P=0.938).结论 非治愈性ESD切除后的早期胃癌患者,需评估淋巴结转移风险.对于转移风险极低且身体状况难以耐受外科手术的老年患者,密切随访也是可选择的治疗策略之一.Objective To investigate the therapeutic strategy in patients with early gastric cancer after noncurative endoscopic submucosal dissection(ESD).Methods A total of 107 cases with early gastric cancer receiving noncurative endoscopic submucosal dissection were collected and the patients were classified into an additional gastrectomy group(n=41)and a simple follow-up group(n=66)according to the therapeutic method used after noncurative ESD.The clinicopathological information,short-and long-term clinical outcomes between the two groups were analyzed and compared.Results The mean age of the patients in the gastrectomy group and follow-up group was(59.2±8.7)years old and(64.7±8.8)years old,respectively.The depth of submucosal invasion was(1445.83±803.12)and(794.71±815.79)μm,respectively.The difference between the two groups was statistically significant(P=0.020 for age and P=0.010 for depth of submucosal invasion).Compared with follow-up group,the patients with undifferentiated histologic type,deep invasion of submucosa(SM2),diffuse type,lymphovascular invasion and neural invasion were more common in the gastrectomy group(P<0.05).The R0 resection rate of ESD in the gastrectomy group was significantly lower than the follow-up group(26.8%vs 65.2%,P<0.001).The positive residual tumor rate and LNM rate of additional gastrectomy group were 31.7%(13/41)and 9.76%(4/41)according to the pathological results after gastrectomy.The gastrectomy group had 2 cases of local recurrence(2/41,4.9%),while 5(5/66,7.6%)in the follow-up group(4.9%vs 7.6%,P=0.883).There was no significant difference in overall survival(OS)and disease-free survival(DFS)between the two study groups(P=0.066 and 0.938,respectively).Conclusions Assessment of LNM risk should be performed in patients with noncurative endoscopic resection.For patients with low risk of LNM who are intolerance of additional gastrectomy due to old age and comorbidities,close follow-up with endoscopy can be considered as an alternative.

关 键 词：胃肿瘤 内镜黏膜下剥离术 淋巴结转移 非治愈性切除 根治性手术 

分 类 号：R73[医药卫生—肿瘤]