摘要
目的探讨食管全周浅表鳞状细胞癌和癌前病变发生黏膜下深浸润及脉管瘤栓的危险因素。方法2013年11月至2021年10月在中国医学科学院肿瘤医院行内镜下切除术的食管鳞状上皮高级别上皮内瘤变20例,食管鳞状细胞癌96例。分析其临床病理特征和内镜下表现,病变发生黏膜下深浸润和脉管瘤栓的影响因素分析采用logistic回归模型。结果116例患者中,术后病理诊断为高级别上皮内瘤变至黏膜下层浅浸润(<200μm)85例(其中高级别上皮内瘤变20例),黏膜下层深浸润(≥200μm)31例,有脉管内瘤栓17例。多因素logistic回归分析显示,饮酒史(OR=3.090,95%CI:1.165~8.200)、病变处食管上皮乳头内毛细血管袢AB分型(OR=11.215,95%CI:3.955~31.797)是浸润深度的独立影响因素,吸烟史(OR=5.824,95%CI:1.704~19.899)、是否存在无血管区或血管杂乱区域(OR=3.393,95%CI:1.285~12.072)是脉管瘤栓的独立影响因素。结论有饮酒史、病变处食管上皮乳头内毛细血管袢分型为B2~B3型的食管全周浅表鳞状细胞癌及癌前病变发生黏膜下层深浸润的风险更高,有吸烟史、存在无血管区或血管杂乱区域的食管全周浅表鳞状细胞癌及癌前病变有脉管瘤栓的可能性更大。超声内镜联合窄带成像+放大内镜检查能提高术前对食管全周浅表鳞状细胞癌及癌前病变浸润深度和脉管瘤栓评估的准确性,帮助内镜医师合理地把握内镜下治疗的指征。
Objective To analyze clinicopathological features of circumferential superficial esophageal squamous cell carcinoma and precancerous lesions and investigate the risk factors for deep submucosal invasion and angiolymphatic invasion retrospectively.Methods A total of 116 cases of esophageal squamous epithelial high-grade intraepithelial neoplasia or squamous cell carcinoma diagnosed by gastroscopy,biopsy pathology and endoscopic resection pathology during November 2013 to October 2021 were collected,and their clinicopathological features were analyzed.The independent risk factors of deep submucosal invasion and angiolymphatic invasion were analyzed by logistic regression model.Results The multivariate logistic regression analysis showed that drinking history(OR=3.090,95%CI:1.165-8.200;P<0.05),The AB type of intrapapillary capillary loop(IPCL)(OR=11.215,95%CI:3.955-31.797;P<0.05)were the independent risk factors for the depth of invasion.The smoking history(OR=5.824,95%CI:1.704-19.899;P<0.05),the presence of avascular area(AVA)(OR=3.393,95%CI:1.285-12.072;P<0.05)were the independent factors for the angiolymphatic invasion.Conclusions The risk of deep submucosal infiltration is greater for circumferential superficial esophageal squamous cell carcinoma patients with drinking history and IPCL type B2-B3 observed by magnifying endoscopy,while the risk of angiolymphatic invasion should be vigilant for circumferential superficial esophageal squamous cell carcinoma patients with smoking history and the presence of AVA observed by magnifying endoscopy.Ultrasound endoscopy combined with narrowband imagingand magnification endoscopy can improve the accuracy of preoperative assessment of the depth of infiltration of superficial squamous cell carcinoma and precancerous lesions and angiolymphaticinvasion in the whole perimeter of the esophagus,and help endoscopists to reasonably grasp the indications for endoscopic treatment.
作者
刘奕
窦利州
薛学敏
刘勇
贺舜
张月明
柯岩
刘旭东
郭嫦媛
薛丽燕
王贵齐
Liu Yi;Dou Lizhou;Xue Xuemin;Liu Yong;He Shun;Zhang Yueming;Ke Yan;Liu Xudong;Guo Changyuan;Xue Liyan;Wang Guiqi(Department of Endoscopy,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Pathology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2023年第2期153-159,共7页
Chinese Journal of Oncology
基金
中国医学科学院医学与健康科技创新工程项目(2021-I2M-1-061、2021-I2M-1-013、2021-I2M-1-015)
深圳市医疗卫生三名工程项目(SZSM201911008)
首都卫生发展科研专项项目(2020-2-4025)。
关键词
食管鳞状细胞癌
食管鳞状上皮高级别上皮内瘤变
全周病变
胃镜
黏膜下深浸润
脉管瘤栓
Esophageal squamous cell carcinoma
Esophageal squamous epithelial high-grade intraepithelial neoplasia
Circumferential lesions
Gastroscopy
Deep submucosal invasion
Angiolymphatic invasion
