内镜治疗早期贲门癌术后合并同时癌的危险因素及预后分析  

Risk factors and prognosis of synchronous tumor of early gastric cardia carcinoma treated by endoscopy

作　　者：秦睿璐 徐桂芳[1] 曹守莉 何怡 黄静雯 孟睿 王雷[1] Qin Ruilu;Xu Guifang;Cao Shouli;He Yi;Huang Jingwen;Meng Rui;Wang Lei(Department of Gastroenterology,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院消化科,210008

出　　处：《中华消化内镜杂志》2020年第10期708-712,共5页Chinese Journal of Digestive Endoscopy

基　　金：国家重点研发计划(2016YFC1303600)。

摘　　要：目的分析合并同时癌的早期贲门癌的临床特点、合并同时癌的危险因素及预后。方法回顾2011年1月—2018年6月在南京鼓楼医院消化内镜中心行内镜黏膜下剥离术治疗且术后病理证实为早期贲门癌的499例患者(512处病灶)的病例资料,其中47例患者(50处病灶)合并同时癌,纳入同时癌组,剩余452例患者(462处病灶)纳入非同时癌组。采用t检验、χ^2检验及Logistic回归分析术后合并同时癌的危险因素,采用Kaplan-Meier法绘制生存曲线,对数秩检验进行生存曲线比较。结果499例患者中有47例(50处病灶)同时癌,发生率为9.4%(47/499)。Logistic回归分析显示,切除病灶大小(P=0.046,OR=0.807,95%CI:0.653~0.996)、萎缩及肠化(P=0.017,OR=3.207,95%CI:1.229~8.371)、幽门螺杆菌感染(P=0.046,OR=1.952,95%CI:1.013~3.761)是早期贲门癌内镜下切除术后合并同时癌的独立危险因素。499例患者中,453例(90.8%)成功随访,Kaplan-Meier曲线显示同时癌组与非同时癌组总体生存率分别为95.2%和97.6%,预后比较差异无统计学意义(P=0.72)。结论早期贲门癌合并同时癌发病率不高但仍不容忽视,若贲门病灶较小,需考虑其他部位合并主癌灶可能;对于合并幽门螺杆菌感染或周围黏膜萎缩肠化严重的患者,行内镜检查时应仔细观察病变以外黏膜情况,同时建议患者进行更严谨的内镜随访。Objective To study the different clinical features of early gastric cardia carcinoma(EGCC)patients with synchronous tumor,and identify the risk factors and prognosis of the occurence of synchronous tumor after endoscopic resection.Methods A retrospective study was made on the data of 499 patients(512 lesions)who underwent cardiac endoscopic submucosal dissection(ESD)and were pathologically confirmed as EGCC in Nanjing Drum Tower Hospital from January 2011 to June 2018.The patients were divided into synchronous tumor group(47 patients with 50 lesions)and non-synchronous tumor group(452 patients with 462 lesions).Univariate and multivariate logistic regression analysis were performed to identify independent risk factors for the occurrence of synchronous tumor.Kaplan-Meier method was conducted to prognosis.Differences between the two groups were analyzed for significance by the log-rank test.Results Among the 499 patients,the incidence of synchronous tumor was 9.4%(47/499).Logistic regression analysis showed that the lesion size(P=0.046,OR=0.807,95%CI:0.653-0.996),atrophic gastritis and intestinal metaplasia(P=0.017,OR=3.207,95%CI:1.229-8.371),Helicobacter pylori infection(P=0.046,OR=1.952,95%CI:1.013-3.761)were independent risk factors for the occurrence of synchronous tumor after endoscopic resection.A total of 453(90.8%)patients were successfully followed up.Kaplan-Meier curve showed that the overall survival rate of the synchronous tumor group and the non-synchronous tumor group were 95.2%and 97.6%,respectively(P=0.72).Conclusion The incidence of EGCC accompanied with synchronous tumor is not high,but it should not be neglected.For patients with small lesions,it is necessary to consider the possibility of main cancer in other parts.For patients with Helicobacter pylori infection or severe mucosal atrophy and intestinal metaplasia,more attention should be paid to the mucosa around the lesion during endoscopic examination and strict endoscopic follow-up should be carried out.

关 键 词：胃肿瘤 早期贲门癌 内镜治疗 同时癌 

分 类 号：R735.2[医药卫生—肿瘤]