治愈性内镜黏膜下剥离术治疗早期贲门与非贲门型胃癌患者的疗效分析  

Efficacy of curative endoscopic submucosal dissection for patients with early cardia and non‑cardia gastric cancer

作　　者：朱铟楠 李明月 陈璐[1] 丁源 施瑞华[1] Zhu Yinnan;Li Mingyue;Chen Lu;Ding Yuan;Shi Ruihua(Department of Gastroenterology,Zhongda Hospital Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院消化内科,南京210009

出　　处：《中华医学杂志》2024年第47期4316-4322,共7页National Medical Journal of China

摘　　要：目的探讨治愈性内镜黏膜下剥离术(ESD)治疗早期贲门与非贲门型胃癌患者的疗效。方法回顾性收集2016年8月至2023年7月于东南大学附属中大医院消化内科接受治愈性ESD治疗的早期胃癌患者的临床资料。根据病灶位置和术后病理,分为贲门组(早期贲门型胃癌及高级别上皮内瘤变的患者)和非贲门组,随访截止时间为2023年10月。比较两组患者基本临床信息、内镜及组织病理学、术后并发症及预后等差异。采用Kaplan‑Meier方法绘制生存曲线,比较两组患者无异时性复发生存率、总生存率的差异。结果共纳入279例患者,贲门组96例(男83例,女13例),年龄[M(Q_(1),Q_(3))]为68(65,74)岁;非贲门组183例(男136例,女47例),年龄67(59,72)岁;术后随访时间为35(22,53)个月。两组在术后病理类型、病灶浸润深度的差异均有统计学意义(均P<0.05),贲门组以高/中分化腺癌[69.8%(67/96)]和T1‑M3浸润深度[58.3%(56/96)]占比最高,非贲门组以高/中分化腺癌[52.5%(96/183)]和T1‑M1浸润深度[43.2%(79/183)]占比最高。贲门组合并食管黏膜病变的比例[13.5%(13/96)比5.5%(10/183)]和深在性囊性胃炎的比例[19.8%(19/96)比2.7%(5/183)]均高于非贲门组(均P<0.05)。两组术后并发症发生率[4.2%(4/96)比2.2%(4/183)]和死亡率[1.0%(1/96)比2.2%(4/183)]的差异均无统计学意义(均P>0.05);贲门组异时性复发的发生率[11.5%(11/96)比4.9%(9/183)]高于非贲门组(P=0.044)。贲门组1、3和5年的无异时性复发生存率分别为97.9%、89.6%和79.8%,非贲门组分别为100.0%、96.3%和92.1%,差异具有统计学意义(P=0.015);贲门组1、3和5年的总生存率分别为100.0%、100.0%和97.1%,非贲门组分别为99.5%、98.3%和98.3%,差异无统计学意义(P=0.597)。结论接受治愈性ESD治疗的早期贲门型胃癌患者的预后较非贲门组差,异时性复发的发生率更高。Objective To analyze the efficacy of curative endoscopic submucosal dissection(ESD)for patients with early cardia and non‑cardia gastric cancer.Methods Clinical data of patients with early gastric cancer who underwent curative ESD treatment in the Department of Gastroenterology,Zhongda Hospital,Southeast University from August 2016 to July 2023 were retrospectively collected.According to the location of lesions and postoperative pathology,the patients were divided into cardia group(early cardia gastric cancer and high‑grade intraepithelial neoplasia)and non‑cardia group.Follow‑up ended in October 2023.Basic clinical information,endoscopy features and histopathological results,postoperative complications and prognosis were compared between the two groups.Kaplan‑Meier method was used to present the survival curve and compare the metachronous recurrence‑free survival rate and overall survival rate between the two groups.Results A total of 279 patients were included,including 96 patients in the cardia group(83 males and 13 females),aged[M(Q_(1),Q_(3))]68(65,74)years,and 183 patients in the non‑cardia group(136 males and 47 females),aged 67(59,72)years.The follow‑up duration after ESD was 35(22,53)months.Differences in postoperative pathological types and lesion invasion depth between the two groups were statistically significant(all P<0.05).The cardia group had the highest proportion of well/moderately differentiated adenocarcinoma[69.8%(67/96)]and T1‑M3 invasion depth[58.3%(56/96)],while the non‑cardia group had the highest proportion of well/moderately differentiated adenocarcinoma[52.5%(96/183)]and T1‑M1 invasion depth[43.2%(79/183)].The proportion of merging esophageal mucosal lesions[13.5%(13/96)vs 5.5%(10/183)]and deep cystic gastritis[19.8%(19/96)vs 2.7%(5/183)]in the cardia group were higher than those in the non‑cardia group(all P<0.05).There were no statistically significant differences in postoperative complication rates[4.2%(4/96)vs 2.2%(4/183)]and mortality rates[1.0%(1/96)vs 2.2%

关 键 词：胃肿瘤 贲门型胃癌 非贲门型胃癌 内镜黏膜下剥离术 预后 异时性复发 

分 类 号：R735.2[医药卫生—肿瘤]