胃上部与胃中下部早期癌的临床病理特征#br# 比较研究#br#

目的对比分析胃上部早期癌（UGC）与胃中下部早期癌（M LGC）的临床及病理特征。方法回顾性分析2016年1月至2020年5月于南京医科大学第一附属医院消化内科接受内镜黏膜下剥离术（ESD）且术后病理证实为早期胃癌（EGC）的379例患者的临床病理资料，根据患者病灶部位分为UGC组（180例）与M LGC组（199例），比较两组患者的基本资料、病灶内镜下特征及随访情况等。采用Logistic回归分析EGC黏膜下浸润及淋巴结转移的危险因素。结果UGC组年龄≥60岁、男性比例高于M LGC组，慢性萎缩性胃炎、肠上皮化生比例低于M LGC组，差异有统计学意义（P<005）。两组巴黎分型、组织学类型、黏膜下浸润、淋巴结转移差异有统计学意义（P<005），肿瘤直径和治愈性切除差异无统计学意义（P>005）。UGC组、M LGC组发生黏膜下浸润者分别有66例、34例。Logistic回归分析显示，胃上部位置、淋巴结转移、未分化型是EGC黏膜下浸润的独立危险因素。肿瘤黏膜下浸润、未分化型是EGC淋巴结转移的独立危险因素。两组短期疗效（整块切除、完全切除、愈性切除、出血、穿孔）和长期疗效（复发、死亡）差异均无统计学意义（P>005）。结论在评估UGC达到ESD适应证的前提下，可优先选择内镜下切除。

Comparative analysis of clinical and pathological of proximal and distal early gastric cancer

ObjectiveTo compare the clinical and pathological features of upper early gastric cancer (UGC) and middle and lower early gastric cancer (M LGC). MethodsWe have retrospectively studied the clinicopathological data of 379 patients with early gastric cancer (EGC) who underwent endoscopic submucosal dissection (ESD) in the Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University from January 2016 to May 2020 Patients were divided into UGC group (180 cases) and M LGC group (199 cases) according to the lesion location. The basic data, endoscopic characteristics and follow up information of two group patients were compared. Logistic regression was used to analyze the risk factors of EGC submucosal infiltration and lymph node metastasis. ResultsUGC group who was older than 60 years old and the proportion of male were higher than M LGC group, but the proportion of chronic atrophic gastritis and intestinal metaplasia were lower than M LGC group, the differences were statistically significant (P<005). There were statistically significant differences in Paris classification, histological type, submucosal infiltration and lymph node metastasis between the two groups (P<005), while there were no statistically significant differences in tumor diameter and curative resection (P>005). There were 66 and 34 cases of submucosal infiltration in UGC group and M LGC group, respectively. Logistic regression analysis showed that upper gastric position, lymph node metastasis and undifferentiated type were independent risk factors for EGC submucosal infiltration. Submucosal invasion and undifferentiated type of tumor were independent risk factors for EGC lymph node metastasis. There were no significant differences in short term efficacy (whole resection, complete resection, healing resection, bleeding and perforation) and long term efficacy (recurrence and death) between the two groups (P>005). ConclusionsUnder the premise of evaluating UGC to reach ESD indication, endoscopic resection is preferred.