摘要
目的 基于符合内镜黏膜下剥离术(ESD)扩大标准的未分化型早期胃癌(UD-EGC)患者的临床及病理特征,分析其发生淋巴结转移(LNM)的危险因素,探讨ESD扩大标准的安全性及可行性。方法 回顾性分析2010年1月至2022年12月在十堰市人民医院行根治性胃切除术且术后证实符合ESD扩大标准的128例UD-EGC患者的临床资料,根据是否存在LNM分为两组,LNM^(+)组24例,LNM^(-)组104例,比较两组临床及病理特征差异,探讨LNM的危险因素,并基于多因素回归模型分析其预测能力。结果 单因素分析结果显示,低分化腺癌伴印戒细胞成分、神经侵犯、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)与LNM差异有统计学意义(P<0.05)。多因素分析表示神经侵犯、高水平NLR及高水平PLR是LNM的独立危险因素。多因素模型预测LNM的曲线下面积为0.886。结论 符合ESD扩大标准的UDEGC患者若合并神经侵犯、高水平NLR及高水平PLR等特征,在选择ESD治疗前需全面评估LNM可能性。
【Objective】Based on the clinical and pathological characteristics of patients with undifferentiated early gastric cancer(UD-EGC)who met the expanded criteria for endoscopic submucosal dissection(ESD),the risk factors for lymph node metastasis were analyzed to explore the safety and feasibility of the expanded criteria for ESD.【Methods】Clinical data of 128 UD-EGC patients who underwent radical gastrectomy in Shiyan People's Hospital from January 2010 to December 2022 and were confirmed to meet the expanded criteria for ESD after surgery were retrospectively analyzed.All the patients were divided into two groups according to the presence or absence of lymph node metastasis(LNM),104 cases in the lymph node metastasis group and 24 cases in the group without lymph node metastasis.The differences in clinical and pathological characteristics between the two groups were compared,the risk factors of LNM were explored and their predictive ability was analyzed based on a multifactorial model.【Results】A univariate analysis showed that poorly differentiated adenocarcinoma with imprinted cell component,nerve invasion,neutrophil to lymphocyte ratio(NLR),and platelet to lymphocyte ratio(PLR)were significantly correlated with LNM.Multifactorial analysis indicated that nerve invasion,high level of NLR and high level of PLR were independent risk factors for LNM.The multifactorial model predicted an area under the curve of 0.886 for LNM.【Conclusion】Patients with UD-EGC who meet the expanded criteria for ESD who have a combination of features such as neurologic invasion,high levels of NLR,and high levels of PLR need to be thoroughly evaluated for the likelihood of lymph node metastasis prior to choosing ESD therapy.
作者
谭静
廖应英
TAN Jing;LIAO Yingying(Department of Gastroenterology,Postgraduate Training Base of People's Hospital of Shiyan City,Jinzhou Medical University,Shiyan,Hubei 442000,China;Department of Gastroenterology,People's Hospital of Shiyan City,Shiyan,Hubei 442000,China)
出处
《中国医学工程》
2025年第9期35-40,共6页
China Medical Engineering
关键词
早期胃癌
内镜黏膜下剥离术
淋巴结转移
预测模型
early gastric cancer
endoscopic submucosal dissection
lymph node metastasis
predictive model
