Comparative study of endoscopic submucosal dissection in the treatment of early gastroesophageal junction cancer and gastric cancer
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摘要:
目的：比较早期胃食管交界处癌与胃癌的临床、病理差异及内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）疗效分析，从而评价ESD治疗早期胃食管交界处癌安全性和有效性。方法：回顾性分析2013年1月—2019年2月在南京医科大学第一附属医院接受ESD治疗且术后病理证实为早癌的338例患者，根据病灶位置，将157例早期胃食管交界处癌为研究组与181例胃癌为对照组进行比较研究。结果：多因素分析年龄≥62.5岁、男性、平坦型腺癌、分化型腺癌及黏膜下层浸润为早期胃食管交界处癌的独立危险因素（OR=2.182、2.299、2.497、2.425、2.939，P < 0.05）。早期胃食管交界处癌手术时间［（104.14 ± 58.49）min vs. （73.39 ± 45.06）min，P＜0.001］长于胃癌组，治愈性切除率低于胃癌组（70.7% vs. 80.7%，P=0.032），差异有统计学意义；经Kaplan-Meier分析，两组总生存率（log-rank P=0.889）及治愈性切除患者生存率差异无统计学意义（Log-rank P=0.712）；单因素分析病灶直径≥2 cm（91.3% vs. 67.6%，P=0.002）、未分化腺癌（21.7% vs. 0.9%，P < 0.001）、黏膜下层浸润（60.9% vs. 13.5%，P < 0.001）、淋巴脉管浸润（4.3% vs. 0，P=0.027）、有溃疡（23.9% vs. 5.4%，P < 0.001）是早期胃食管交界处癌非治愈性切除的危险因素。结论：ESD是治疗早期胃食管交界处癌的安全有效方法，但病灶直径≥2 cm、病理类型分化差、黏膜下层浸润、淋巴脉管浸润、有溃疡的早期胃食管交界处癌ESD治疗治愈性切除率降低。
Abstract:
Objective：The purpose of this study was to compare the difference of clinical and pathological features between early gastroesophageal junction cancer and gastric cancer and analyze the endoscopic submucosal dissection （ESD） efficacy，to evaluate the ESD safety and effectiveness of early gastroesophageal junction cancer. Methods：We retrospectively analyzed 338 patients who underwent ESD in the First Affiliated Hospital of Nanjing Medical University from January 2013 to February 2019，who were confirmed as early cancer by postoperative pathology. According to the location of lesions，157 cases of early gastroesophageal junction cancer were studied as the study group and 181 cases of gastric cancer as the control group. Results：Multivariate analysis showed that age ≥62.5 years，male，endoscopic flat type，differentiated adenocarcinoma and submucosal infiltration were independent risk factors for early gastroesophageal junction cancer（OR=2.182，2.299，2.497，2.425，2.939，P < 0.05）. The operation time of the early gastroesophageal junction cancer group［（104.14 ± 58.49）min］was longer than that of the gastric cancer group［（73.39 ± 45.06）min，P＜0.05］，and the curative resection rate was lower than that of the gastric cancer group（70.7% vs. 80.7%，P=0.032）. According to Kaplan-Meier analysis，there was no statistically significant difference in the overall survival rate（Log-rank P=0.889）and the survival rate of patients with curative resection（log-rank P=0.712） between the two groups. Univariate analysis showed that lesion diameter ≥2 cm（91.3% vs. 67.6%，P=0.002），poor pathological type（21.7% vs. 0.9%，P < 0.001），submucosal infiltration（60.9% vs. 13.5%，P < 0.001），lymphatic vascular infiltration（4.3% vs. 0，P=0.027），ulceration（23.9% vs. 5.4%，P < 0.001） were risk factors for noncurative resection of early gastroesophageal junction cancer. Conclusion：ESD is a safe and effective treatment for early gastroesophageal junction cancer，but the curative rate of ESD treatment is reduced for early gastroesophageal junction cancer with lesion diameter ≥2 cm，poor pathological type differentiation，submucosal infiltration，lymphatic vessel infiltration and ulcer.
