早期食管病变内镜黏膜下剥离术后辅助治疗人群的预测模型  

Prediction model for selection of adjuvant therapy population after endoscopic submucosal dissection for early esophageal lesions

作　　者：古丽斯坦·阿布拉 宋文轩 刘航 任祥凤 陈鑫[1] Gulisitan Abula;Wen-Xuan Song;Hang Liu;Xiang-Feng Ren;Xin Chen(Department of Gastroenterology and Hepatology,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院消化内科,天津市300052

出　　处：《世界华人消化杂志》2022年第13期587-598,共12页World Chinese Journal of Digestology

摘　　要：背景早期食管病变在无明显转移或浸润时均可以首选内镜下治疗,尤其是内镜黏膜下剥离术(endoscopic submucosal dissection,ESD),然而术后非治愈性切除、复发或转移等不良事件的发生是不可避免的,可能需要追加手术或放化疗等辅助治疗.目的分析ESD治疗早期食管病变后需要追加手术或放化疗的危险因素,并探讨治愈性切除对追加辅助治疗的影响.方法回顾性分析本中心因T1期食管癌及癌前病变行ESD者,随访患者术后复发、转移以及辅助治疗的情况,并建立辅助治疗人群选择的预测模型.结果患者年龄、病灶环周比例、镜下大小与ESD术后非治愈性切除相关(P<0.05),而且环周比例>2/3(OR=7.958,P=0.007)是独立危险因素.治愈性/非治愈性切除者中分别有2例/10例追加了手术或放化疗,即不论是否为治愈性切除均有辅助治疗者.年龄、环周比例、病灶抬举情况、分化情况、脉管侵袭、浸润深度等与ESD术后需要辅助治疗相关(P<0.05),年龄≥70岁(OR=4.210,P=0.049)、病灶抬举不良(OR=18.171,P=0.047)、浸润至SM2层(OR=38.781,P=0.012)是独立危险因素.列线图模型的曲线下面积为0.864(95%CI:0.766-0.962),特异度和灵敏度分别为95.8%和75.0%,校准曲线、决策曲线、Hosmer and Lemeshow检验(χ^(2)=1.5954,P=0.991)等显示该模型预测价值尚可.结论T1期食管癌及癌前病变者在ESD术后不能仅靠病理为非治愈性而追加手术或放化疗,而应结合患者情况、内镜表现及术后病理等综合评估.BACKGROUND Endoscopic treatment is the first choice for early esophageal lesions without obvious metastasis or infiltration, especially endoscopic submucosal dissection(ESD). However, the occurrence of non-curative resection, recurrence, or metastasis after ESD is inevitable, which may require adjuvant therapy such as additional surgery or chemoradiotherapy.AIM To analyze the risk factors for additional surgery or chemoradiotherapy after ESD for early esophageal lesions, and explore the effect of curative resection on additional adjuvant therapy.METHODS Patients who underwent ESD for stage T1 esophageal cancer(EC) and precancerous lesions were analyzed retrospectively. Postoperative recurrence, metastasis, and adjuvant treatment were followed, and a prediction model for adjuvant treatment population selection was established.RESULTS Non-curative resection was correlated with patient age, proportion of lesions, and microscopic size(P < 0.05), among which the proportion of lesions > 2/3(odds ratio [OR] = 7.958, P = 0.007) was an independent risk factor. Two of curative and ten of non-curative resection cases received additional treatment, indicating that further treatment after ESD might be required regardless of whether curative resection was performed. Patient age, proportion of lesions, lesion lifting, differentiation, vascular invasion, and tumor invasion depth were correlated with the need for further treatment(P < 0.05). Age ≥ 70 years(OR = 4.210, P = 0.049), poor lifting(OR = 18.171, P = 0.047), and depth of tumor up to SM2(OR = 38.781, P = 0.012) were independent risk factors. The AUC of the nomogram model was 0.864(95%CI: 0.766-0.962);the specificity and sensitivity were 95.8% and 75.0%, respectively. Calibration curve analysis, decision curve analysis, and Hosmer and Lemeshow test(χ^(2)= 1.5954, P = 0.991) showed that the predictive value of the model was acceptable.CONCLUSION For patients with stage T1 EC and precancerous lesions, whether further surgery or chemoradiotherapy is needed after ESD should

关 键 词：食管癌 癌前病变 内镜粘膜下剥离术 非治愈性切除 列线图 

分 类 号：R735.1[医药卫生—肿瘤]