结直肠侧向发育型肿瘤并发结直肠息肉的预测因子及发生恶变的危险因素  

Predictors of colorectal polyps complicating colorectal laterally spreading tumors and the risk factorsformalignancyincoexistence

作　　者：张展鹏 郝钰洁 严艳[1] Zhang Zhanpeng;HaoYujie;Yan Yan(Department of Gastroenterology,The Second Afiliated Hospital of Dalian Medical University,Dalian I16000,China;Department of Gastroenterology,Heping Hospital Affiliated to Changzhi Medical College,Changzhi 046000,China)

机构地区：[1]大连医科大学附属第二医院消化内科,大连116000 [2]长治医学院附属和平医院消化内科,长治046000

出　　处：《中华消化内镜杂志》2023年第7期527-533,共7页Chinese Journal of Digestive Endoscopy

摘　　要：目的探究结直肠侧向发育型肿瘤(colorectal laterally spreading tumors, CLST)并发结直肠息肉的独立预测因子及CLST合并结直肠息肉发生恶变的独立危险因素。方法回顾性收集2016年1月-2021年12月在大连医科大学附属第二医院行内镜检查发现CLST, 并接受内镜下治疗的260例患者的临床资料。根据是否与结直肠息肉共存将CLST患者分为共存组(n=135)与非共存组(n=125), 比较两组的临床病理特征差异, 采用二元Logistic回归分析共存现象的预测因子。根据共存组CLST的浸润深度, 将共存组分为共存恶性组(n=38)与共存非恶性组(n=97), 采用二元Logistic回归分析CLST合并结直肠息肉发生恶性变的危险因素。结果男性(P=0.002, OR=2.355, 95%CI:1.354~4.099)、绒毛管状腺瘤(P=0.022, OR=3.873, 95%CI:1.214~12.355)、既往有息肉病史(P=0.001, OR=2.738, 95%CI:1.527~4.909)是CLST合并结直肠息肉的独立危险因素。该预测模型受试者工作特征(receiver operator characteristic, ROC)曲线的曲线下面积(area under the curve, AUC)为0.725(P<0.001, 95%CI:0.664~0.786)。息肉直径≥10 mm(P=0.007, OR=6.266, 95%CI:1.634~24.034)、CLST直径≥20 mm(P<0.001, OR=11.879, 95%CI:4.078~34.601)、结节混合型CLST(P=0.003, OR=8.584, 95%CI:2.126~34.660)、扁平隆起型CLST(P=0.021, OR=4.399, 95%CI:1.250~15.482)、假凹陷型CLST(P<0.001, OR=31.426, 95%CI:4.975~198.509)是CLST合并息肉发生恶性变的危险因素。该预测模型ROC曲线AUC为0.854(P<0.001, 95%CI:0.775~0.933)。结论既往有息肉病史、病理类型为绒毛管状腺瘤的男性CLST患者更易发生共存现象。息肉直径和CLST直径越大, 结节混合型、扁平隆起型和假凹陷型的CLST合并结直肠息肉患者更容易发生恶变。Objective To investigate the independent predictors of colorectal polyps complicating colorectal laterally spreading tumors(CLST)and the independent risk factors for malignancy in CLST coexisting with colorectal polyps.Methods Clinical data of 260 patients with CLST who underwent endoscopy and received treatment in the Second Affiliated Hospital of Dalian Medical University from January 2016 to December 2021 were retrospectively collected.Patients were divided into the coexisting group(n=135)and the non-coexisting group(n=125)according to the presence or absence of polyps.Differences in clinicopathological characteristics between the two groups were compared and binary logistic regression was used to analyse the predictors of coexistence.Then the coexisting group was further divided into coexisting malignant group(n=38)and coexisting non-malignant group(n=97)according to the infiltration depth of CLST,and binary logistic regression was used to analyse the risk factors for malignancy in CLST coexisting with colorectal polyps.Results Male(P=0.002,OR=2.355,95%CI:1.354-4.099),villous tubular adenoma(P=0.022,0R=3.873,95%CI:1.214-12.355)and polyps history(P=0.001,OR=2.738,95%Cl:1.527-4.909)were independent predictors for colorectal polyps coexisting with CLST.Area under the curve(AUC)of the predictive model was 0.725(P<0.001,95%CI:0.664-0.786).Polyp diameter≥10 mm(P=0.007,0R=6.266,95%CI:1.634-24.034),CLST diameter≥20 mm(P<0.001,0R=11.879,95%CI:4.078-34.601),granular-mixed type CLST(P=0.003,0R=8.584,95%CI:2.126-34.660),flat-elevated type CLST(P=0.021,0R=4.399,95%CI:1.250-15.482)and pseudo-depressed type CLST(P<0.001,0R=31.426,95%Cl:4.975-198.509)were independent risk factors for malignancy in CLST coexisting with polyps.AUC of the predictive model was 0.854(P<0.001,95%CI:0.775-0.933).Conclusion Male CLST patients with polyps history and a pathological type of villous tubular adenoma are more likely to develop coexistence.In patients with CLST which is granular-mixed type,flat-elevated type and pseudo-depressed type

关 键 词：结直肠肿瘤 侧向发育型肿瘤 结直肠息肉 病理学 

分 类 号：R735.34[医药卫生—肿瘤]