胃早期分化型管状腺癌黏膜下层浸润的危险因素分析  

Risk factors for submucosal invasion of early gastric differentiated tubular adenocarcinoma

作　　者：覃俊富 莫凌山 黄学 QIN Jun-fu;MO Ling-shan;HUANG Xue(Department of Gastroenterology,Eighth Affiliated Hospital of Guangxi Medical University,Guigang 537100,China)

机构地区：[1]广西医科大学第八附属医院消化内科,537100

出　　处：《中国实用医药》2024年第1期24-27,共4页China Practical Medicine

摘　　要：目的探讨胃早期分化型管状腺癌黏膜下层浸润的危险因素。方法回顾性分析经病理证实的行内镜黏膜下剥离术(ESD)治疗的140例胃早期分化型管状腺癌患者的临床资料,共148处病灶。根据浸润深度将胃早期分化型管状腺癌病灶分为黏膜内浸润(123处)和黏膜下层浸润(25处)。统计分析患者的基线特征,对胃早期分化型管状腺癌黏膜下层浸润进行单因素及多因素Logistic回归分析。结果140例患者中男性113例(80.71%),女性27例(19.29%),年龄为34~91岁,中位年龄为68(61,73)岁。140例患者共有148处病灶,病灶长径为1.5~95 mm,长径中位数为16(8,26.5)mm;浸润深度:局限在黏膜层(黏膜内浸润)123处(83.11%),黏膜下层浸润25处(16.89%),其中浸润至黏膜下层浅层16处,浸润至黏膜下层深层9处。高分化管状腺癌75处,高中分化管状腺癌61处,中分化管状腺癌12处。单因素分析表明,黏膜内浸润与黏膜下层浸润的性别、年龄、病灶位置、内镜下形态、黏液表型、免疫组化P53阳性及Ki67>50%表达情况比较,差异无统计学意义(P>0.05);黏膜内浸润与黏膜下层浸润的病灶长径≥2 cm、组织学有中分化成分的占比比较,差异有统计学意义(P<0.05)。将单因素分析有意义的结果病灶长径≥2 cm、组织学有中分化成分,进一步行多因素Logistic回归分析表明:病灶长径≥2 cm[OR=2.808,95%CI=(1.050,7.508),P=0.040<0.05]、组织学有中分化成分[OR=6.080,95%CI=(1.937,19.086),P=0.002<0.05]是胃早期分化型管状腺癌黏膜下层浸润的独立危险因素。结论胃早期分化型管状腺癌中病灶长径≥2 cm、组织学具有中分化成分者易出现黏膜下层浸润。Objective To investigate the risk factors for submucosal invasion of early gastric differentiated tubular adenocarcinoma.Methods The data of 140 patients with early gastric differentiated tubular adenocarcinoma,who underwent endoscopic submucosal dissection(ESD),were retrospectively analyzed,with 148 lesions.Early gastric differentiated tubular adenocarcinoma lesions were categorized into intramucosal infiltration(123 sites)and submucosal infiltration(25 sites)according to the depth of invasion.The baseline characteristics of the patients were statistically analyzed,and univariate and multivariate Logistic regression analyses were performed for submucosal invasion of gastric early differentiated tubular adenocarcinoma.Results Among the 140 patients,there were 113 males(80.71%)and 27 females(19.29%),aged 34-91 years,with a median age of 68(61,73)years.There were 148 lesions in 140 patients,with long diameter ranging 1.5-95 mm and a median of 16(8,26.5)mm;the depth of invasion:123 lesions(83.11%)were confined to the mucous membrane layer(intramucosal invasion),and 25 lesions(16.89%)were infiltrated to the submucosal layer,including 16 lesions infiltrated to the superficial submucosal layer and 9 lesions infiltrated to the deeper submucosal layer.There were 75 highly differentiated tubular adenocarcinomas,61 moderately differentiated tubular adenocarcinomas,and 12 moderately differentiated tubular adenocarcinomas.Univariate analysis showed that there was no significant difference in gender,age,lesion location,endoscopic morphology,mucous phenotype,immunohistochemical P53 positive and Ki67>50%expression between patients with intramucosal invasion and submucosal layer(P>0.05).The difference was statistically significant(P<0.05)when comparing the percentage of long diameter≥2 cm and a moderately differentiated component by histology between patients with intramucosal invasion and submucosal layer invasion.Further multifactorial Logistic regression analysis of the results that were significant in the univariate analys

关 键 词：早期胃癌 管状腺癌 浸润深度 危险因素 

分 类 号：R735.2[医药卫生—肿瘤]