基于食管低级别上皮内瘤变病理活检特征构建内镜黏膜下层剥离术后病理升级的风险列线图模型  

Construction of a risk nomogram model for pathological upgrading after endoscopic submucosal dissection based on pathological characteristics of low-grade intraepithelial neoplasia of the esophagus

作　　者：吴仙 曹正龙[2] 李森华[1] WU Xian;CAO Zhenglong;LI Senhua(Department of Pathology,Tianchang Hospital of Traditional Chinese Medicine,Chuzhou 239300,China)

机构地区：[1]天长市中医院病理科,安徽滁州239300 [2]天长市中医院消化内科,239300

出　　处：《临床肿瘤学杂志》2023年第8期713-718,共6页Chinese Clinical Oncology

摘　　要：目的探讨影响食管低级别上皮内瘤变(LGIN)患者内镜黏膜下层剥离术(ESD)后病理升级的相关因素并构建风险列线图模型。方法根据术前活检结果将本院2018年6月至2022年6月行ESD的食管病变患者291例分为食管癌、LGIN和高级别上皮内瘤变(HGIN),比较不同食管病变患者的基线资料,根据ESD后病理结果并依据术后是否发生病理升级将LGIN患者分为升级组和未升级组。对比升级组和未升级组患者的临床资料及术前病理特征。多因素分析影响LGIN患者ESD后病理升级的相关因素并构建风险列线图模型。结果291例食管病变患者中60例为食管癌、81例为LGIN、150例为HGIN,且食管癌标本最长径、未经窄带成像技术(NBI)联合碘染率和黏膜表面发红率大于HGIN、LGIN(P<0.05),而HGIN的上述指标大于LGIN(P<0.05)。81例LGIN的ESD后病理升级率为45.68%,且病理升级组结节样改变占比、黏膜表面发红占比、未经NBI联合碘染占比和标本最长径高于未升级组(P<0.05)。多因素分析结果显示,结节样改变(OR=2.962,95%CI:1.298~6.761)、黏膜表面发红(OR=3.203,95%CI:1.554~6.601)、未经NBI联合碘染(OR=3.059,95%CI:1.405~6.660)和标本最长径(OR=3.370,95%CI:1.619~7.015)均为影响LGIN患者ESD后病理升级的独立因素(P<0.05)。列线图模型预测ESD后病理升级的灵敏度为72.97%(95%CI:55.61%~85.63%),特异度为84.09%(95%CI:69.33%~92.84%),曲线下面积为0.814(95%CI:0.713~0.892)。结论结节样改变、黏膜表面发红、未经NBI联合碘染和标本最长径与LGIN患者ESD后病理升级有关,建立的列线图模型评估LGIN患者ESD后病理升级风险的效能良好。Objective To investigate the related factors affecting the pathological upgrading after endoscopic submucosal dissection(ESD)in patients with esophageal low-grade intraepithelial neoplasia(LGIN),and to construct a risk nomogram model.Methods Two hundred and ninety-one patients with esophageal lesions who underwent ESD at our hospital from June 2018 to June 2022 were divided into esophageal cancer,LGIN and high-grade intraepithelial neoplasia(HGIN)based on preoperative biopsy results.Baseline data of patients with different esophageal lesions were compared.LGIN patients were divided into upgraded and non-upgraded groups based on the postoperative pathological results of ESD and whether pathological escalation occurred after surgery.Clinical data and preoperative pathological characteristics of the patients between both groups were compared.Multivariate analysis of the relevant factors affecting the pathological upgrade of LGIN patients after ESD was performed and then a risk nomogram model was constructed.Results Among the 291 patients with esophageal lesions,60 were esophageal cancer,81 were LGIN and 150 were HGIN.The longest diameter,non-narrowband imaging(NBI)combined iodine staining rate,and mucosal surface redness rate of esophageal cancer specimens were higher than those of HGIN and LGIN(P<0.05),while the above indicators of HGIN were higher than those of LGIN(P<0.05).The postoperative pathological upgrade rate of 81 LGIN patients was 45.68%.The proportion of nodular changes,mucosal surface redness,proportion of non-NBI combined iodine staining,and longest diameter of specimens in the pathological upgrade group were higher than those in the non-upgrade group(P<0.05).Results of multivariate analysis showed that nodular changes(OR=2.962,95%CI:1.298-6.761),mucosal surface redness(OR=3.203,95%CI:1.554-6.601),non-NBI combined iodine staining(OR=3.059,95%CI:1.405-6.660)and the longest diameter of the specimen(OR=3.370,95%CI:1.619-7.015)were independent related factors that affected the pathological progression of

关 键 词：食管癌 食管低级别上皮内瘤变 内镜黏膜下层剥离术 病理升级 列线图模型 

分 类 号：R735.1[医药卫生—肿瘤]