Analysis in risk factors for submucosal invasive carcinoma developed by colorectal laterally spreading tumor of granular type
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摘要:目的
探讨结直肠颗粒型侧向发育型肿瘤(LST-G)癌变为黏膜下浸润癌的危险因素。
方法回顾性选择消化内科收治的320例结直肠LST-G患者作为研究对象, 均行内镜黏膜下剥离术(ESD)治疗，根据术后病理结果将其分为黏膜下浸润癌发生组36例和黏膜下浸润癌未发生组284例。比较2组患者一般资料、病变特征，采用多因素Logistic回归分析探讨LST-G癌变为黏膜下浸润癌的危险因素。绘制受试者工作特征(ROC)曲线，计算曲线下面积(AUC), 评价病变直径、最大结节直径联合病变位于直肠对LST-G癌变为黏膜下浸润癌的诊断效能。
结果黏膜下浸润癌发生组的有肠癌家族史者占比、病变直径、最大结节直径、病变部位为直肠者占比均高于或大于黏膜下浸润癌未发生组，差异有统计学意义(P < 0.001)。多因素Logistic回归分析结果显示，有肠癌家族史、病变直径≥38.25mm、最大结节直径≥14.33mm、病变位于直肠均是结直肠LST-G癌变为黏膜下浸润癌的危险因素(OR=16.994, 95%CI: 1.409~198.265, P=0.027;OR=1.308, 95%CI: 1.008~1.721, P=0.041;OR=28.654, 95%CI: 4.615~187.265, P < 0.001;OR=1.411, 95%CI: 1.015~1.819, P=0.033)。病变直径、最大结节直径、病变位于直肠联合诊断LST-G癌变为黏膜下浸润癌的AUC为0.891(95%CI: 0.814~0.932), 敏感度为89.82%, 特异度为75.37%, 显著优于病变直径、最大结节直径分别联合病变位于直肠的诊断效能(Z=2.678, P=0.007;Z=3.188, P=0.001)。
结论有肠癌家族史、病变直径≥38.25mm、最大结节直径≥14.33mm、病变位于直肠均是结直肠LST-G癌变为黏膜下浸润癌的危险因素，且病变直径、最大结节直径、病变位于直肠三者联合对结直肠LST-G癌变为黏膜下浸润癌的诊断效能最佳。
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关键词:
- 颗粒型侧向发育型肿瘤 /
- 结直肠肿瘤 /
- 内镜黏膜下剥离术 /
- 黏膜下浸润癌 /
- 癌变
Abstract:ObjectiveTo investigate the risk factors for submucosal invasive carcinoma developed by colorectal laterally spreading tumor of granular type(LST-G).
MethodsA total of 320 patients with colorectal LST-G admitted to the Department of Gastroenterology were retrospectively selected as study subjects, all of them underwent endoscopic submucosal dissection (ESD). According to the postoperative pathological results, the patients were divided into submucosal invasive carcinoma group (36 cases) and non-occurrence of submucosal invasive carcinoma group (284 cases). General data and pathological characteristics of the two groups were compared, and multivariate Logistic regression analysis was used to explore the risk factors of submucosal invasive carcinoma developed by colorectal LST-G. Receiver operating characteristic (ROC) curve was drawn; the area under the curve (AUC) was calculated. The diagnostic efficacy of the lesion diameter and maximum nodule diameter combined with location of the lesion in the rectum for submucosal invasive carcinoma developed by colorectal LST-G was evaluated.
ResultsThe proportion of patients with family history of colorectal cancer, lesion diameter, maximum nodule diameter and proportion of patients with site of lesion in the rectum in the submucosal invasive carcinoma group were higher or more than those in the non-occurrence of submucosal invasive carcinoma group (P < 0.001). Multivariate Logistic regression analysis showed that family history of colorectal cancer, lesion diameter≥38.25 mm, maximum nodule diameter≥14.33 mm and site of lesion in the rectum were risk factors for submucosal invasive carcinoma developed by colorectal LST-G (OR=16.994, 95%CI, 1.409 to 198.265, P=0.027; OR=1.308, 95%CI, 1.008 to 1.721, P=0.041; OR=28.654, 95%CI, 4.615 to 187.265, P < 0.001; OR=1.411, 95%CI, 1.015 to 1.819, P=0.033). The AUC of lesion diameter and maximum nodule diameter combined with site of lesion in the rectum in the diagnosis of submucosal invasive carcinoma developed by colorectal LST-G was 0.891 (95%CI, 0.814 to 0.932), the sensitivity was 89.82%, and the specificity was 75.37%, which were significantly better than the diagnostic efficiency of the lesion diameter and maximum nodule diameter separately combined with site of lesion in the rectum(Z=2.678, P=0.007; Z=3.188, P=0.001).
ConclusionFamily history of colorectal cancer, lesion diameter≥38.25 mm, maximum nodule diameter≥14.33 mm, and site of lesion in the rectum are the risk factors of submucosal invasive carcinoma developed by colorectal LST-G. Lesion diameter, maximum nodule diameter combined with site of lesion in the rectum has the best efficacy in diagnosis of submucosal invasive carcinoma developed by colorectal LST-G.
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表 1 2组患者一般资料比较(x±s)[n(%)]
指标 分类 黏膜下浸润癌发生组(n=36) 黏膜下浸润癌未发生组(n=284) χ2/t P 性别 男 19(52.78) 160(56.34) 2.170 0.141 女 17(47.22) 124(43.66) 年龄/岁 65.15±11.62 66.02±12.51 0.420 0.675 体质量指数/(kg/m2) 27.15±3.58 27.54±3.67 0.614 0.540 肠癌家族史 有 3(8.33) 10(3.52) 25.076 < 0.001 无 33(91.67) 274(96.48) 吸烟史 有 23(63.89) 188(66.20) 1.001 0.317 无 13(36.11) 96(33.80) 饮酒史 有 20(55.56) 160(56.34) 0.105 0.746 无 16(44.44) 124(43.66) 
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表 2 2组患者病变特征比较(x±s)[n(%)]
特征 黏膜下浸润癌发生组(n=36) 黏膜下浸润癌未发生组(n=284) t/F P 病变直径/mm 41.02±10.55 32.48±9.24 4.635 < 0.001 最大结节直径/mm 15.24±3.41 11.15±2.94 6.877 < 0.001 病变部位 右半结肠 10(27.78) 151(53.17) 15.623 < 0.001 左半结肠 4(11.11) 22(7.75) 直肠 22(61.11) 111(39.08)
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表 3 LST-G癌变为黏膜下浸润癌的多因素Logistic回归分析
因素 SE β Wald χ2 OR 95%CI P 肠癌家族史 2.841 1.282 4.998 16.994 1.409~198.265 0.027 病变直径 0.269 0.142 3.699 1.308 1.008~1.721 0.041 最大结节直径 3.398 0.938 11.554 28.654 4.615~187.265 < 0.001 病变位于左半结肠 0.368 0.242 2.994 1.211 0.991~1.609 0.119 病变位于直肠 3.288 1.552 4.456 1.411 1.015~1.819 0.033
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表 4 病变直径、最大结节直径联合病变位于直肠对LST-G癌变为黏膜下浸润癌的诊断效能
项目 AUC 95%CI 敏感度/% 特异度/% 阳性预测值/% 阴性预测值/% Z P 病变直径联合病变位于直肠 0.768 0.718~0.823 78.45 75.62 81.68 71.69 2.678 0.007 最大结节直径联合病变位于直肠 0.801 0.722~0.831 73.38 79.34 83.17 68.27 3.188 0.001 病变直径、最大结节直径联合病变位于直肠 0.891 0.814~0.932 89.82 75.37 83.49 84.27 — —
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[1] TAN L, TAN Y, WANG H, et al. Single tunnel-assisted endoscopic submucosal dissection for a 13-cm giant colorectal laterally spreading tumor[J]. Rev Esp Enferm Dig, 2020, 112(2): 150-151.
[2] JUNG J S, HONG J Y, OH H H, et al. Clinical outcomes of endoscopic resection for colorectal laterally spreading tumors with advanced histology[J]. Surg Endosc, 2019, 33(8): 2562-2571. doi: 10.1007/s00464-018-6550-0
[3] D'AMICO F, MASELLI R, GALTIERI P A, et al. Endoscopic submucosal dissection of a rectal nongranular laterally spreading tumor with the use of a new endoscopic platform[J]. VideoGIE, 2019, 4(3): 140-141. doi: 10.1016/j.vgie.2018.12.011
[4] YOSHIDA A, KAWAGUCHI K, YASHIMA K, et al. Endoscopic submucosal dissection for a laterally spreading tumor involving the colon diverticulum using a knife with water supply function[J]. VideoGIE, 2020, 5(5): 207-209. doi: 10.1016/j.vgie.2020.02.001
[5] SHIGITA K, OKA S, TANAKA S, et al. Clinical significance and validity of the subclassification for colorectal laterally spreading tumor granular type[J]. J Gastroenterol Hepatol, 2016, 31(5): 973-979. doi: 10.1111/jgh.13238
[6] 许炎钦, 林峥嵘, 钟世顺, 等. 老年人结直肠侧向发育型肿瘤恶变相关危险因素分析[J]. 中华消化内镜杂志, 2020, 37(12): 892-897. doi: 10.3760/cma.j.cn321463-20200630-00583 [7] KITA A, TANAKA H, RAMBERAN H, et al. Endoscopic submucosal dissection of early-stage rectal cancer using full-time red dichromatic imaging to minimize and avoid significant bleeding[J]. VideoGIE, 2021, 6(4): 193-194. doi: 10.1016/j.vgie.2020.12.001
[8] 邓嘉文, 房静远. 锯齿状结直肠癌的癌变途径和临床特点[J]. 中华医学杂志, 2020, 100(34): 2716-2720. doi: 10.3760/cma.j.cn112137-20191230-02854 [9] ISHIGAKI T, KUDO S E, MIYACHI H, et al. Treatment policy for colonic laterally spreading tumors based on each clinicopathologic feature of 4 subtypes: actual status of pseudo-depressed type[J]. Gastrointest Endosc, 2020, 92(5): 1083-1094. doi: 10.1016/j.gie.2020.04.033
[10] 陈健, 张肖丽, 张月晓, 等. 内镜黏膜下剥离术在结直肠侧向发育型肿瘤患者中的治疗效果及对Wnt和整合素信号通路的影响[J]. 中国内镜杂志, 2019, 25(9): 41-47. doi: 10.3969/j.issn.1007-1989.2019.09.008 [11] 亢倩玉, 宋顺喆, 宫爱霞. 结直肠侧向发育型肿瘤黏膜下层侵犯的危险因素分析[J]. 中华消化内镜杂志, 2020, 37(12): 930-933. doi: 10.3760/cma.j.cn321463-20200304-00541 [12] D'AMICO F, AMATO A, IANNONE A, et al. Risk of covert submucosal cancer in patients with granular mixed laterally spreading tumors[J]. Clin Gastroenterol Hepatol, 2021, 19(7): 1395-1401. doi: 10.1016/j.cgh.2020.07.024
[13] 史大敏, 陈蓉, 谯秋建. 内镜下黏膜剥离术治疗直肠近肛门处巨大侧向发育型肿瘤的临床价值[J]. 中华消化病与影像杂志: 电子版, 2016, 6(1): 36-38. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYE201601010.htm [14] SUDO G, TANUMA T, FUJISAWA T, et al. Traction-assisted endoscopic submucosal dissection for a previously tattooed colonic laterally spreading tumor[J]. VideoGIE, 2021, 6(7): 329-332. doi: 10.1016/j.vgie.2021.03.009
[15] SHICHIJO S, TAKEUCHI Y, WAKI K, et al. Pulley traction-assisted endoscopic submucosal dissection with hemostatic forceps for a laterally spreading tumor in the ascending colon[J]. VideoGIE, 2020, 5(12): 684-685. doi: 10.1016/j.vgie.2020.07.008
[16] 冯轶, 牛应林, 李鹏, 等. 结直肠侧向发育型肿瘤的内镜表现及病理特点研究[J]. 中国内镜杂志, 2019, 25(1): 79-84. doi: 10.3969/j.issn.1007-1989.2019.01.016 [17] 李大欢, 邓超男, 徐晓雯, 等. 直径≥ 20 mm结直肠侧向发育型肿瘤内镜病理特征的分析[J]. 贵州医科大学学报, 2020, 45(8): 954-958. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYB202008016.htm -
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