基于内镜特征的黏膜下层浸润危险因素分析：聚焦未分化型早期胃癌

Risk Factors Analysis of Submucosal Invasion Based on Endoscopic Characteristics: A Focus on Undifferentiated-Type Early Gastric Cancer

摘要: 目的：研究未分化型早期胃癌黏膜下层浸润的危险因素，为临床制定个体化治疗方案提供循证医学依据。方法：收集2016年3月至2024年3月于我院接受ESD治疗的早期胃癌患者的资料，根据病理结果分为黏膜层组和黏膜下层组，比较两组特征，有意义变量进行多因素logistic分析。结果：纳入132例，其中黏膜层组101例，黏膜下层组31例，病变特征为溃疡(OR值3.366，95% CI 1.861~7.672)、发红(OR值2.950，95% CI 1.556~7.664)、表面结节(OR值4.044，95% CI 1.058~5.146)、病变位于胃上1/3 (OR值11.175，95% CI 1.929~64.733)多因素分析P < 0.05，可视为未分化型早期胃癌黏膜下层浸润的独立危险因素。结论：溃疡、发红、表面结节、病灶位于胃上1/3为未分化型早期胃癌黏膜下层浸润的高危病变，需要更积极地进行干预。

Abstract: Objective: To investigate the risk factors for submucosal invasion in undifferentiated-type early gastric cancer (UD-EGC) and provide evidence-based guidance for individualized clinical decision-making. Methods: We retrospectively analyzed data from patients who underwent endoscopic submucosal dissection (ESD) for early gastric cancer at our hospital between March 2016 and March 2024. Based on pathological results, patients were divided into a mucosal layer group and a submucosal layer group. Clinicopathological characteristics were compared between the two groups, and significant variables were further analyzed using multivariate logistic regression. Results: A total of 132 patients were included, with 101 in the mucosal layer group and 31 in the submucosal layer group. Multivariate analysis identified the following independent risk factors for submucosal invasion (P < 0.05): Ulceration (OR 3.366, 95% CI 1.861~7.672), redness (OR 2.950, 95% CI 1.556~7.664), nodular surface (OR 4.044, 95% CI 1.058~5.146), tumor location in the upper third of the stomach (OR 11.175, 95% CI 1.929~64.733). Conclusion: Ulceration, redness, nodular surface, and tumor location in the upper third of the stomach are high-risk features for submucosal invasion in UD-EGC. These findings suggest that more aggressive interventions should be considered for such lesions.