内镜黏膜下剥离术治疗消化道早期癌及癌前病变长期疗效的单中心回顾性队列分析*

A retrospective cohort study of the long-term effects of endoscopic submucosal dissection in treating early gastrointestinal cancer or precancerous lesions*

摘要:

目的 研究内镜黏膜下剥离术（ESD）治疗消化道早癌或癌前病变的长期疗效以及术后复发的 影响因素。方法 收集73 例患者的临床及随访资料。采用Kaplan-Meier 法，Log-rank 和Breslow 检验，以及 Cox 风险比例模型进行统计学分析。结果 胃和结直肠ESD 术后中位无复发生存时间（DFS）大于该研究 最长随访时间（65 个月），食管中位生存时间为44.5 个月；与胃和结直肠相比，食管ESD 术后DFS 明显减少 （χ2=12.61，P =0.000；χ2=7.09，P =0.008）；病灶异型程度（浸润深度）和病灶面积影响ESD 术后DFS（P =0.027， OR^ =2.38，95%CI ：1.10 ～ 5.12 ；P =0.074，OR ^ =0.90，95%CI ：0.80 ～ 1.01）。结论 ESD 术是切除消化道早 期癌和癌前病变并维持长期不复发的有效内镜下手术方法；异型程度（浸润深度）是影响ESD 术后DFS 的 独立危险因素；病灶面积在影响ESD 术后的DFS 方面具有临床意义。

Abstract:

Objective A retrospective cohort study was carried out to observe the long-term effect of ESD in treating early gastrointestinal cancer or precancerous lesions. Methods The clinical and follow-up data of 73 patients were collected. Kaplan-Meier, Log-rank and Breslow test and Cox’s proportional hazards regression model were used to analyze the data. Results The median survival time in the gastric and colo-rectal early cancer or precancerous lesions is longer than 65 months in our study, respectively. For esophagus, the median survival time was 44.5 months; the disease free survival time (DFS) after ESD was significantly reduced in the esophagus, compared to the stomach and colo-rectum (χ2 = 12.61, P = 0.000; χ2 = 7.09, P = 0.008); the degree of atypia (or infiltration), and lesion size were considered to be two factors to influence the DFS after ESD (P = 0.027, OR^ =2.38, 95%CI: 1.10 ~ 5.12, P = 0.074, 95%CI; OR^ =0.90, 95%CI: 0.80 ~ 1.01). Conclusion ESD is an effective curative treatment in the resection of early upper gastrointestinal cancer and precancerous lesions. The degree of atypia (or infiltration) was concluded as an independent risk factor for the DFS post-ESD, and the size of lesion was a valuable parameter with regard to the recurrence after ESD procedure.