早期食管基底细胞样鳞状细胞癌的内镜特征及预后分析

Endoscopic characteristics and prognosis of early esophageal basaloid squamous cell carcinoma

摘要:

目的 研究早期食管基底细胞样鳞状细胞癌（EBSCC）的内镜特征、治疗效果及预后。方法 回顾性分析2014年1月－2020年12月该院发现并行ESD治疗的早期EBSCC患者32例（EBSCC组），纳入同期行内镜黏膜下剥离术（ESD）治疗的普通典型早期食管鳞状细胞癌（ESCC）患者96例作为对照组（ESCC组），对比分析两组患者年龄、性别、肿瘤大小、肿瘤浸润深度、内镜特征、治疗结果及生存率等。结果 两组患者发病年龄（P = 0.746）、性别（P = 0.506）、肿瘤大小（P = 0.423）和肿瘤浸润深度（P = 0.914）比较，差异均无统计学意义。两组患者肿瘤均好发于食管中段，内镜下分型以0-Ⅱb型为主，所有病灶表面黏膜均粗糙和/或糜烂，放大内镜观察上皮内乳头状毛细血管袢（IPCL），以B1型为主，两组患者比较，差异无统计学意义（P > 0.05）。EBSCC组较ESCC组病灶表面白斑出现的概率更高，差异有统计学意义（56.25%和26.04%，χ² = 9.88，P = 0.002）。碘液染色：EBSCC组有17例（53.12%）为不染或淡染，15例（46.88%）有斑驳状不染改变（即碘不染区域中可见岛状染色斑点或者深染斑点）；ESCC组有72例（75.00%）为不染或淡染，24例（25.00%）有斑驳状不染改变，两组患者碘液染色后改变比较，差异有统计学意义（χ² = 5.42，P = 0.020）。两组患者治疗后生存率比较，差异无统计学意义（93.75%和96.88%，χ² = 0.62，P = 0.429）。结论 早期EBSCC内镜下表现不一致，病灶表面白斑、碘液染色后呈斑驳状不染改变和放大内镜结合窄带成像技术观察到B型血管，提示可能存在基底细胞样鳞状细胞癌（BSCC）成分。早期治疗EBSCC可提高患者生存率，改善预后。

Abstract:

Objective To study the endoscopic characteristics, therapeutic effect and prognosis of early esophageal basaloid squamous cell carcinoma (EBSCC).Methods A retrospective analysis was conducted on 32 cases of early EBSCC treated with endoscopic submucosal dissection (ESD from January 2014 to December 2020 (EBSCC group), and 96 cases of common typical early esophageal squamous cell carcinoma (ESCC) treated with ESD during the same period were selected as the control group (ESCC group). The age, gender, tumor size, depth of tumor invasion, endoscopic characteristics, treatment results and survival rate were compared and analyzed between the two groups.Results There were no significant differences in age (P = 0.746), sex composition (P = 0.506), tumor size (P = 0.423) and tumor invasion depth (P = 0.914) between the two groups. The tumors in both groups were mostly in the middle esophagus, and the main types were 0-IIb under endoscopy, and the superficial mucosa of all lesions were coarse and/or erosion. The intraepithelial papillary capillary loop (IPCL) was mainly B1 type after magnification, with no statistical difference (P > 0.05). The incidence of leukoplakia was significantly higher in EBSCC group than in ESCC group (56.25% vs 26.04%, χ² = 9.88, P = 0.002). In the iodine solution stained EBSCC group, 17 cases (53.12%) showed no staining or light staining, and 15 cases (46.88%) showed mottled non-staining changes (staining spots or deep staining spots were visible in the iodine free area). In ESCC group, 72 cases (75.00%) showed no staining or light staining, and 24 cases (25.00%) showed mottled nonstaining. There was significant difference between the two groups after iodine solution staining (χ² = 5.42, P = 0.020). There was no significant difference in survival rate between the two groups after treatment (93.75% vs 96.88%, χ² = 0.62, P = 0.429).Conclusion The endoscopic manifestations of early esophageal basaloid squamous cell carcinoma were inconsistent, with leukoplakia on the lesion surface, mottled unstained changes after iodine staining, and type-B IPCL by magnifying endoscopy-narrow band imaging, suggesting the possible presence of basaloid squamous cell carcinoma(BSCC) components. Early treatment of EBSCC can improve survival rate and prognosis.