结直肠颗粒型侧向发育型肿瘤癌变为黏膜下浸润癌的危险因素分析  

Analysis in risk factors for submucosal invasive carcinoma developed by colorectal laterally spreading tumor of granular type

作　　者：陈志华[1] 郑秀芳[1] 韩东 王齐全 谭露露[2] CHEN Zhihua;ZHENG Xiufang;HAN Dong;WANG Qiquan;TAN Lulu(Digestive Department,Haikou Hospital Affiliated to Xiangya Medical College of Central South University,Haikou,Hainan,570208;Department of Oncology and Radiotherapy,Hainan Provincial People′s Hospital,Haikou,Hainan,570311)

机构地区：[1]中南大学湘雅医学院附属海口医院消化内科,海南海口570208 [2]海南省人民医院肿瘤放疗科,海南海口570311

出　　处：《实用临床医药杂志》2022年第23期26-30,共5页Journal of Clinical Medicine in Practice

基　　金：海南省卫生计生行业科研项目(18A200160)。

摘　　要：目的探讨结直肠颗粒型侧向发育型肿瘤(LST-G)癌变为黏膜下浸润癌的危险因素。方法回顾性选择消化内科收治的320例结直肠LST-G患者作为研究对象,均行内镜黏膜下剥离术(ESD)治疗,根据术后病理结果将其分为黏膜下浸润癌发生组36例和黏膜下浸润癌未发生组284例。比较2组患者一般资料、病变特征,采用多因素Logistic回归分析探讨LST-G癌变为黏膜下浸润癌的危险因素。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价病变直径、最大结节直径联合病变位于直肠对LST-G癌变为黏膜下浸润癌的诊断效能。结果黏膜下浸润癌发生组的有肠癌家族史者占比、病变直径、最大结节直径、病变部位为直肠者占比均高于或大于黏膜下浸润癌未发生组,差异有统计学意义(P<0.001)。多因素Logistic回归分析结果显示,有肠癌家族史、病变直径≥38.25 mm、最大结节直径≥14.33 mm、病变位于直肠均是结直肠LST-G癌变为黏膜下浸润癌的危险因素(OR=16.994,95%CI:1.409~198.265,P=0.027;OR=1.308,95%CI:1.008~1.721,P=0.041;OR=28.654,95%CI:4.615~187.265,P<0.001;OR=1.411,95%CI:1.015~1.819,P=0.033)。病变直径、最大结节直径、病变位于直肠联合诊断LST-G癌变为黏膜下浸润癌的AUC为0.891(95%CI:0.814~0.932),敏感度为89.82%,特异度为75.37%,显著优于病变直径、最大结节直径分别联合病变位于直肠的诊断效能(Z=2.678,P=0.007;Z=3.188,P=0.001)。结论有肠癌家族史、病变直径≥38.25 mm、最大结节直径≥14.33 mm、病变位于直肠均是结直肠LST-G癌变为黏膜下浸润癌的危险因素,且病变直径、最大结节直径、病变位于直肠三者联合对结直肠LST-G癌变为黏膜下浸润癌的诊断效能最佳。Objective To investigate the risk factors for submucosal invasive carcinoma developed by colorectal laterally spreading tumor of granular type(LST-G).Methods A total of 320 patients with colorectal LST-G admitted to the Department of Gastroenterology were retrospectively selected as study subjects,all of them underwent endoscopic submucosal dissection(ESD).According to the postoperative pathological results,the patients were divided into submucosal invasive carcinoma group(36 cases)and non-occurrence of submucosal invasive carcinoma group(284 cases).General data and pathological characteristics of the two groups were compared,and multivariate Logistic regression analysis was used to explore the risk factors of submucosal invasive carcinoma developed by colorectal LST-G.Receiver operating characteristic(ROC)curve was drawn;the area under the curve(AUC)was calculated.The diagnostic efficacy of the lesion diameter and maximum nodule diameter combined with location of the lesion in the rectum for submucosal invasive carcinoma developed by colorectal LST-G was evaluated.Results The proportion of patients with family history of colorectal cancer,lesion diameter,maximum nodule diameter and proportion of patients with site of lesion in the rectum in the submucosal invasive carcinoma group were higher or more than those in the non-occurrence of submucosal invasive carcinoma group(P<0.001).Multivariate Logistic regression analysis showed that family history of colorectal cancer,lesion diameter≥38.25 mm,maximum nodule diameter≥14.33 mm and site of lesion in the rectum were risk factors for submucosal invasive carcinoma developed by colorectal LST-G(OR=16.994,95%CI,1.409 to 198.265,P=0.027;OR=1.308,95%CI,1.008 to 1.721,P=0.041;OR=28.654,95%CI,4.615 to 187.265,P<0.001;OR=1.411,95%CI,1.015 to 1.819,P=0.033).The AUC of lesion diameter and maximum nodule diameter combined with site of lesion in the rectum in the diagnosis of submucosal invasive carcinoma developed by colorectal LST-G was 0.891(95%CI,0.814 to 0.932),the sensi

关 键 词：颗粒型侧向发育型肿瘤 结直肠肿瘤 内镜黏膜下剥离术 黏膜下浸润癌 癌变 

分 类 号：R735.3[医药卫生—肿瘤] R57[医药卫生—临床医学]