早期胃癌内镜下治疗的非治愈性切除率及影响因素

目的 探讨早期胃癌内镜下治疗的非治愈性切除率及影响因素。方法 收集2014年1月至2020年8月于首都医科大学附属北京友谊医院消化内科住院诊治的早期胃癌患者的相关资料,对切除的治愈性进行评估,计算非治愈性切除的发生率,分析其危险因素。结果 共纳入347例早期胃癌病变,其中非治愈性切除病变66例,非治愈性切除率为19.02%(66/347)。采用多因素Logistic分析得出病变直径≥20 mm(OR=3.248,95%CI:1.451~7.272,P=0.004)、病变浸润至黏膜下层(OR=26.549,95%CI:10.087~69.875,P<0.001)及病理类型为未分化型早期胃癌(OR=18.021,95%CI:6.664~48.736,P<0.001)是非治愈性切除的独立影响因素。结论 对于病变直径≥20 mm、术前病理提示浸润至黏膜下层和/或未分化型早期胃癌者,应经充分评估后,慎重选择内镜下治疗。

Incidence and influence factors of endoscopic non-curative resection of early gastric cancer

Objective To explore the incidence and influence factors of non-curative resection after endoscopic resection of early gastric cancer. Methods We retrospectively collected the relevant data of patients with early gastric cancer who were hospitalized in the Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University from January 2014 to August 2020, and then we evaluated the resection's curability, calculated the incidence of non-curative resection, and analyzed its influence factors. Results A total of 347 lesions of early gastric cancer were included, of which 66 were non-curative resection lesions, thus the non-curative resection rate was 19.02% (66/347). Multivariate Logistic analysis showed that the lesions with diameter ≥20 mm (OR=3.248, 95%CI: 1.451-7.272, P=0.004), infiltration into submucosa (OR=26.549, 95%CI:10.087-69.875, P<0.001) and the pathological type of undifferentiated early gastric cancer (OR=18.021, 95%CI: 6.664-48.736, P<0.001) were influence independent factors for non-curative resection. Conclusion The endoscopic resection should be applied carefully after full evaluation for early gastric cancer with diameter ≥20 mm and infiltration into submucosa and/or undifferentiated pathological type as suggested by preoperative pathology.