内镜黏膜下剥离术治疗早期胃印戒细胞癌的疗效及非治愈性切除的危险因素分析

目的探讨内镜黏膜下剥离术(ESD)治疗早期胃印戒细胞癌(SRCC)的疗效及预后,并探讨非治愈性切除的危险因素。方法回顾性分析2012年10月至2020年10月在南京大学医学院附属鼓楼医院、南京医科大学附属无锡人民医院、泰州市人民医院、南京市高淳人民医院行ESD治疗的62例早期胃SRCC患者的临床病理资料,根据术后病理结果分为治愈性切除组34例和非治愈性切除组28例,收集患者性别、年龄、肿瘤大小及部位、大体分型、浸润深度、切缘、溃疡及术后随访情况等进行分析。结果整块切除率为100%(n=62),完全切除率为83.9%(n=52),治愈性切除率为54.8%(n=34)。术中穿孔率为1.6%(n=1),迟发出血率为1.6%(n=1)。28例非治愈性切除的患者中,20例追加了外科手术,死亡2例,其中1例在外科手术后死于术后出血,另1例在外科手术后死于术后感染。8例非治愈性切除的患者没有追加外科手术,其中2例患者死于淋巴结转移。ESD治愈性切除组的5年生存率明显高于ESD非治愈性切除组,组间差异有统计学意义(P=0.023)。肿瘤直径>20 mm(OR=59.73,95%CI=9.94~358.87,P<0.001)及溃疡是(OR=24.49,95%CI=2.11~284.72,P=0.011)是早期胃SRCC非治愈性切除的独立危险因素。结论达到内镜下治愈性切除标准的早期胃SRCC患者,预后明显好于非治愈性切除的患者。肿瘤直径>20 mm和溃疡为早期胃SRCC非治愈性切除的独立危险因素。

The outcomes of endoscopic submucosal dissection for early signet ring cell gastric carcinomas and the risk factors for non-curative resection:A retrospective multicenter study

Objective To identify the effects and outcomes of Endoscopic submucosal dissection(ESD)applied to treat early gastric Signet ring cell carcinoma(SRCC)and explore the risk factors for non-curative resection.Methods A retrospective analysis was performed on 62 cases of early gastric SRCC treated with ESD diagnosed in Gastroenterology Department of Affiliated Drum Tower Hospital of Nanjing University Medical School,Affiliated Wuxi People′s Hospital of Nanjing Medical University,Taizhou People′s Hospital,Nanjing Gaochun People′s Hospital from October 2012 to October 2020.According to postoperative pathological results,the patients were divided into two groups:the curative resection group(n=34)and non-curative resection group(n=28).Gender,age,tumor size and site,gross type,infiltration depth,tumor margin,ulcer and postoperative follow-up were collected for analysis.ResultsThe enbloc resection rate was 100%(n=62),the complete resection rate was 83.9%(n=52),and the curative resection rate was 54.8%(n=34).The rate of intraoperative perforation was 1.6%(n=1)and the rate of delayed bleeding was 1.6%(n=1).Of the 28 patients who underwent non-curative resection,20 had additional surgery,2 died,of which 1 died of postoperative hemorrhage after surgery and 1 died of postoperative infection after surgery.Eight patients were treated without additional surgery for non-curative resection,and two of them died of lymph node metastasis.The 5-year survival rate of the group with ESD curative resection was significantly higher than that of the group without ESD curative resection,and the difference between groups was statistically significant(P=0.023).Tumor diameter of>20 mm(OR=59.73,95%CI=9.94~358.87,P<0.001)and ulcer(OR=24.49,95%CI=2.11~284.72,P=0.011)are independent risk factors for early non-curative gastric SRCC resection.Conclusion The prognosis of patients with early gastric SRCC who meet the criteria of curative resection under endoscopy is significantly better than that of patients with non-curative resection.Tumor diameter of>20 mm and ulcer are independent risk factors for early gastric SRCC non-curative resection.