食管鳞状上皮内瘤变内镜黏膜下剥离术后病理升级的危险因素分析

饶星宇 蒲柯 崔逵 莫琳 蹇顺海 杨国栋

饶星宇, 蒲柯, 崔逵, 莫琳, 蹇顺海, 杨国栋. 食管鳞状上皮内瘤变内镜黏膜下剥离术后病理升级的危险因素分析[J]. 中国肿瘤临床, 2023, 50(19): 988-992. doi: 10.12354/j.issn.1000-8179.2023.20230785
引用本文: 饶星宇, 蒲柯, 崔逵, 莫琳, 蹇顺海, 杨国栋. 食管鳞状上皮内瘤变内镜黏膜下剥离术后病理升级的危险因素分析[J]. 中国肿瘤临床, 2023, 50(19): 988-992. doi: 10.12354/j.issn.1000-8179.2023.20230785
Xingyu Rao, Ke Pu, Kui Cui, Lin Mo, Shunhai Jian, Guodong Yang. Analysis of risk factors for histopathological upgrade after endoscopic submucosal dissection for esophageal squamous intraepithelial neoplasia[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(19): 988-992. doi: 10.12354/j.issn.1000-8179.2023.20230785
Citation: Xingyu Rao, Ke Pu, Kui Cui, Lin Mo, Shunhai Jian, Guodong Yang. Analysis of risk factors for histopathological upgrade after endoscopic submucosal dissection for esophageal squamous intraepithelial neoplasia[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(19): 988-992. doi: 10.12354/j.issn.1000-8179.2023.20230785

食管鳞状上皮内瘤变内镜黏膜下剥离术后病理升级的危险因素分析

doi: 10.12354/j.issn.1000-8179.2023.20230785
基金项目: 本文课题受国家自然科学基金项目 (编号:81960430)和四川省胰腺疾病重点实验平台项目(编号:18SXHZ0371)资助
详细信息
    作者简介:

    饶星宇:专业方向为消化道肿瘤的早诊早治研究

    通讯作者:

    杨国栋 ygd_ld2003@163.com

Analysis of risk factors for histopathological upgrade after endoscopic submucosal dissection for esophageal squamous intraepithelial neoplasia

Funds: This work was supported by the National Natural Science Foundation of China(No. 81960430) and the Construction of Key Experimental Platform for Pancreatic Diseases in Sichuan Province (No. 18SXHZ0371)
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  • 摘要:   目的  分析内镜钳夹活检术(endoscopic forceps biopsy,EFB)提示食管鳞状上皮内瘤变的患者,行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)后组织病理升级的危险因素。  方法  回顾性分析2019年11月至2023年5月于川北医学院附属医院就诊的术前EFB提示食管鳞状上皮内瘤变并接受ESD手术的255例患者共255处病灶,按术前EFB与ESD术后病理差异分为升级组(n=123)与未升级组(n=132),采用单因素和多因素Logistic回归分析危险因素。  结果  低级别上皮内瘤变(low-grade intraepithelial neoplasia,LGIN)组术前EFB与ESD术后病理一致率为42.9%(18/42),病理升级率为57.1%(24/42);高级别上皮内瘤变(high-grade intraepithelial neoplasia,HGIN)组术前EFB与ESD术后病理一致率为44.1%(94/213),病理升级率为46.0%(98/213),9.9%(21/213)病理降级为LGIN。单因素分析结果提示饮酒史、乳头内毛细血管袢(intrapapillary capillary loop,IPCL)分型、糜烂、溃疡或出血、病变纵向直径≥2 cm、病变累及管腔范围≥1/2差异均具有统计学意义(均P<0.05);多因素分析结果提示B2/B3型IPCL(P=0.001)、病变纵向直径≥2 cm(P=0.014)、病变累及管腔范围≥1/2(P<0.001)是ESD术后病理升级的独立危险因素。  结论  对于内镜下提示B2/B3型IPCL、病变纵向直径≥2 cm、病变累及管腔范围≥1/2的病灶,临床医生应高度警惕病灶病变程度被低估的可能性。

     

  • 图  1  1例典型病例显示术前EFB和ESD术后标本之间的组织病理学差异

    A:白光镜下可见黏膜粗糙发红病变;B:ME-NBI:B1型IPCL;C:ESD术后组织标本;D:术前EFB示HGIN(H&E×100);E:ESD术后病检示食管鳞状细胞癌,浸润至黏膜固有层(H&E×100);F:ESD术后病检示食管鳞状细胞癌,浸润至黏膜固有层(H&E×200)

    表  1  术前EFB与ESD术后的病理结果比较

    术前活检 ESD术后病理
    LGIN HGIN ESCC 合计
    LGIN 18 19* 5* 42
    HGIN 21+ 94 98* 213
    合计 39 113 103 255
    *:病理升级;+:病理降级
    下载: 导出CSV

    表  2  术前EFB示食管鳞状上皮内瘤变ESD术后病理升级的单因素分析 处 (%)

    变量 未升级组
    n=132)
    升级组
    n=123)
    χ2 P
    性别
     女 56(42.4) 45(36.6) 0.907 0.341
     男 76(57.6) 78(63.4)
    年龄(岁)
     <60 32(24.2) 26(21.1) 0.349 0.555
     ≥60 100(75.8) 97(78.9)
    吸烟史
     无 91(68.9) 73(59.3) 2.551 0.110
     有 41(31.1) 50(40.7)
    饮酒史
     无 107(81.1) 82(66.7) 6.877 0.009
     有 25(18.9) 41(33.3)
    IPCL分型
     B1 113(85.6) 81(65.9) 13.65 <0.001
     B2/B3 19(14.4) 42(34.1)
    白苔
     无 87(65.9) 71(57.7) 1.810 0.179
     有 45(34.1) 52(42.3)
    黏膜色泽改变
     正常 38(28.8) 27(22.0) 2.505 0.286
     发白 7(5.3) 4(3.3)
     发红 87(65.9) 92(74.8)
    病变部位
     颈段 2(1.5) 2(1.6) 1.770 0.624a
     胸上段 23(17.4) 17(13.8)
     胸中段 67(50.8) 58(47.2)
     胸下段 40(30.3) 46(37.4)
    粉色征
     阴性 36(27.3) 26(21.1) 1.302 0.254
     阳性 96(72.7) 97(78.9)
    糜烂、溃疡或出血
     无 112(84.8) 92(74.8) 4.021 0.045
     有 20(15.2) 31(25.2)
    病变纵向直径(cm)
     <2 49(37.1) 19(15.4) 15.295 <0.001
     ≥2 83(62.9) 104(84.6)
    累及管腔范围
     <1/4 1(0.8) 0 27.524 <0.001a
     1/4~1/2 55(41.6) 17(13.8)
     1/2~3/4 56(42.4) 70(56.9)
     ≥3/4 20(15.2) 36(29.3)
    大体分型
     隆起 7(5.3) 15(12.2) 4.492 0.106
     平坦 116(87.9) 97(78.9)
     凹陷 9(6.8) 11(8.9)
    活检(块)
     1 82(62.1) 75(61.0) 1.247 0.558a
     2~3 47(35.6) 42(34.1)
     ≥4 3(2.3) 6(4.9)
    ()内单位为%;a:采用Fisher概率确切法
    下载: 导出CSV

    表  3  术前EFB显示食管鳞状上皮内瘤变ESD术后病理升级的多因素分析

    变量 β OR 95%CI P
    IPCL分型
     B1 参考变量
     B2/B3 1.163 3.198 1.646~6.213 0.001
    病变纵向直径(cm)
     <2 参考变量
     ≥2 0.831 2.295 1.186~4.440 0.014
    累及管腔范围
     <1/2 参考变量
     ≥1/2 1.282 3.603 1.864~6.965 <0.001
    下载: 导出CSV
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  • 收稿日期:  2023-08-14
  • 录用日期:  2023-10-24
  • 修回日期:  2023-10-16

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