表浅型食管癌经内镜黏膜下剥离术导致非治愈性切除的危险因素及长期生存分析

陈梦雪; 桑楠; 葛献; 陈嘉希; 黄倩; 李学良

doi:10.3971/j.issn.1000-8578.2020.19.0691

表浅型食管癌经内镜黏膜下剥离术导致非治愈性切除的危险因素及长期生存分析

Risk Factors of Non-curative Resection in Superficial Esophageal Cancer After Endoscopic Submucosal Dissection and Long-term Survival Analysis

摘要

摘要:
目的探讨表浅型食管癌（SEC）经内镜黏膜下剥离术（ESD）后导致非治愈性切除的危险因素及其预后情况。
方法回顾性分析214处SEC病变（207例患者）行食管ESD治疗的情况。共随访15~102月，中位随访时间48月。
结果所有病例中，整块切除率89.25%（191/214），完全切除率80.84 %（173/214），治愈性切除率70.09%（150/214），非治愈取切除率29.91%（64/214），切除标本最大长径110 mm。单因素分析结果显示，年龄、性别、肿瘤体积、术时病灶抬举情况和手术时间与术后导致非治愈性切除相关（P < 0.05）。多因素分析结果显示：女性、肿瘤长径≥50 mm、术时病灶抬举欠佳是术后导致非治愈性切除的危险因素。在非治愈切除组中，ESD后无任何相关治疗的患者与接受开放手术的、放化疗的患者的无癌生存期、生存期差异均无统计学意义。
结论对于一般状况差的、不愿行外科手术及放化疗的非治愈性切除患者，定期内镜检查亦不失为一个可能的选择。

Abstract:
Objective To identify risk factors of non-curative resection in superficial esophageal cancer (SEC) after endoscopic submucosal dissection and to evaluate the prognosis.
Methods We retrospectively analyzed the data of 207 SEC patients who received ESD. The median follow-up was 48 months.
Results The en bloc resection rate was 89.25% (191/214), the complete resection rate was 80.84 % (173/214), the curative resection rate was 70.09% (150/214) and the non-curative resection rate was 29.91% (64/214). The maximum long diameter of specimen was 110 mm. Age, gender, tumor size, lesions performance during surgery and operation time were associated with the non-curative resection (P < 0.05). Female, lesion diameter≥50mm and poorly performed lesions were identified as significant risk factors for non-curative resection. In the non-curative resection group, there was no difference in cancer-free survival and survival between patients who had no additional treatmeat after ESD and those who underwent surgery or radiotherapy.
Conclusion For patients with poor general condition who are not willing to undergo surgery or chemoradiotherapy, regular endoscopy seems to be an option.

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