The National Natural Science Foundation of China (General Program, Key Program, Major Research Plan)
目的 结直肠侧向发育型肿瘤(laterally spreading tumors, LSTs)癌变率高达8.4%～52.5%，未经治疗的LST可在3年内进展为腺癌，本研究旨在分析多发性LST的临床病理特征及癌变风险因素。 方法 回顾性分析2010年1月至2020年12月在江苏省人民医院消化内科经结肠镜检查确诊的209例LST患者的临床资料。 结果 共222处LST病灶纳入研究，颗粒均一型LST(LST-G-homogenous type, LST-G-H)30处（13.5%），结节混合型LST(LST-G-mixed type, LST-G-M)64处（28.8%），扁平隆起型LST(LST-NG-flat elevated type, LST-NG-F)118处（53.2%），假凹陷型LST(LST-NG-peseudodepressed, LST-NG-PD)10处（4.5%）。其中，多发性LST共15处病灶，好发于右半结肠（80.0%，12/15），病理以低级别上皮内瘤变为主（66.7%，10/15），以内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)为主要的治疗手段（60.0%，9/15），有肠息肉病史的患者更易出现多发性LST，多发性LST以LST-G-H型多见，单发性以LST-NG-F型多见。多因素Logistic回归分析表明，病灶长径＞20mm和内镜医师年资低(OR 5.074，95% CI 2.011-12.801，P < 0.05)是LST癌变的独立风险因素，其中病灶长径≥40mm(OR 5.468，95% CI 1.792-16.684，P < 0.05)癌变风险更高。 结论 病灶长径＞20mm和内镜医师年资低是LST癌变的独立风险因素，有肠息肉病史的患者更易出现多发性LST，且以LST-G-H型多见，单发性则以LST-NG-F型多见。
Objective Laterally spreading tumors (LSTs) have a carcinogenesis rate of 8.4% to 52.5%, and untreated LSTs can develop into adenocarcinoma within 3 years. The aim of this study was to analyze the clinicopathological features and carcinogenesis risk factors of multiple LSTs. Method A total of 222 LSTs were included in the study, including 30 LST-G-homogenous type (LST-G-H) (13.5%), 64 LST-G-mixed type (LST-G-M) (28.8%), 118 LST-NG-flat elevated type (LST-NG-F) (53.2%) and 10 LST-NG-peseudodepressed (LST-NG-PD) (4.5%). A total of 15 Multiple LSTs, occurred in the right colon (80.0%, 12/15), the pathology was mainly low-grade dysplasia (66.7%, 10/15), with endoscopic submucosal dissection (ESD) as the main treatment (60.0%, 9/15). Patients with a history of colon polyps were more likely to appear multiple LSTs. Multiple LSTs were more common in LST-G-H type, and single LSTs were more common in LST-NG-F type. Multivariate Logistic regression analysis showed that the size of lessions > 20mm and the junior endoscopic physicians (OR 5.074, 95%CI 2.011-12.801, P < 0.05) were independent risk factors for LSTs carcinogenesis, in which the size of lessions ≥40mm(OR 5.468, 95%CI 1.792-16.684, P < 0.05) had a higher risk of carcinogenesis. Conclusions The size of lessions > 20mm and the junior endoscopic physicians were independent risk factors for LSTs carcinogenesis. Patients with a history of colon polyps were more likely to appear multiple LSTs. Multiple LSTs were more common in LST-G-H type, and single LSTs were more common in LST-NG-F type.