食管早癌内镜黏膜下剥离术后复发的影响因素分析  

Analysis in influencing factors of recurrence after endoscopic submucosal dissection for early esophageal cancer

作　　者：蒋秋福 王瑞[2] 冯美萍 刘洋 JIANG Qiufu;WANG Rui;FENG Meiping;LIU Yang(the Seventh People′s Hospital of Chengdu City in Sichuan Province,Chengdu,Sichuan,610200;West China Hospital of Sichuan University,Chengdu,Sichuan,610200;Sichuan Cancer Hospital,Chengdu,Sichuan,610041)

机构地区：[1]四川省成都市第七人民医院,四川成都610200 [2]四川大学华西医院,四川成都610200 [3]四川省肿瘤医院,四川成都610041

出　　处：《实用临床医药杂志》2023年第19期46-49,55,共5页Journal of Clinical Medicine in Practice

基　　金：四川省医学(青年创新)科研课题(S20002)。

摘　　要：目的 采用Lasso-Logistic回归模型分析食管早癌内镜黏膜下剥离术(ESD)后复发的危险因素。方法 选取2019年1月—2020年10月300例食管早癌患者为研究对象,均行ESD治疗。记录术后12个月复发率,并采用Lasso-Logistic回归模型分析食管早癌ESD后复发的危险因素。结果 术后12个月随访,10例因随访意识差失访,5例因电话号码更换失访。28例患者复发,复发率为9.82%(28/285),其中18例纵隔淋巴结转移(64.29%), 10例远处转移(35.71%)。本研究选择lambda. min=0.004时为最优模型,此时共有3个变量(病灶平均直径、创面环周黏膜缺损程度、病理分型)进入模型;采用赤池信息准则(AIC)和贝叶斯信息准则(BIC)评估其拟合效果,结果表明Lasso-Logistic回归模型筛选出的变量拟合和预测效果相对较好。结论 ESD治疗食管早癌具有显著疗效,但术后存在复发风险,且病灶平均直径、创面环周黏膜缺损程度、病理分型是其影响因素。Objective To analyze the risk factors of recurrence after endoscopic submucosal dis-section(ESD)for early esophageal cancer by using Lasso-Logistic regression model.Methods A total of 300 patients with early esophageal cancer from January 2019 to October 2020 were selected as research objects,and all of them were treated with ESD.The recurrence rate at 12 months after sur-gery was recorded,and the risk factors of recurrence after ESD for early esophageal cancer were ana-lyzed by using Lasso-Logistic regression model.Results At 12-month postoperative follow-up,10 cases were lost due to poor fllow-up awareness,and 5 cases were lost due to change of telephone number.A total of 28 patients experienced recurrence,with a recurrence rate of 9.82%(28/285),including 18 cases of mediastinal lymph node metastasis(64.29%)and 10 cases of distant metastasis(35.71%).In this study,we chose the optimal model at lambda.min=0.004,and a total of 3 var-iables(mean lesion diameter,degree of peri-traumatic mucosal defect,and pathological staging)en-tered the model;the fitting effect was assessed by using the Akaike Information Criterion(AIC)and the Bayesian Information Criterion(BIC),and the results indicated that the variables screened by the Lasso-Logistic regression model fitted and predicted relatively well.Conclusion ESD has a signifi-cant efficacy in the treatment of patients with early esophageal cancer,but there is a risk of recurrence after surgery,and mean lesion diameter,degree of peri-traumatic mucosal defect and pathological staging are the influencing factors.

关 键 词：食管早癌 内镜下黏膜剥离术 手术效果 复发 影响因素 

分 类 号：R735.1[医药卫生—肿瘤] R61[医药卫生—临床医学]