内镜下胃粘膜下剥离术后切缘阳性患者肿瘤残留或复发的回顾性分析

Retrospective Analysis of Residual or Recurrence of Tumor in Patients with Positive Margin after Endoscopic Submucosal Gastric Dissection

摘要: 目的：本研究通过对内镜下胃粘膜下剥离术后切缘阳性患者肿瘤残留或复发的回顾性分析来探讨评估切缘阳性患者的残留/复发肿瘤的发生率及临床、病理特征，并探究增加残留/复发的风险的因素，避免不必要的手术。方法：对在青岛大学附属医院内镜中心行内镜下粘膜剥离术治疗1002例患者的临床及病理资料进行回顾性分析，并将58例标本切缘肿瘤阳性的患者分为有残留/复发肿瘤和无残留/复发肿瘤两组，比较临床病理特征。结果：1) 术后进行外科切除手术的16名患者中残留肿瘤/淋巴结转移的患者共8名；随访的45名患者有2名患者分别于7、21个月发现局部复发；最终统计包括淋巴结转移在内的肿瘤残留/复发率为17.2% (10/58)。2) 统计学分析显示切缘类型(P = 0.012)、组织分化类型(P = 0.001)以及浸润深度(P = 0.004)与肿瘤残留/复发显著相关。结论：内镜下胃粘膜下剥离术后肿瘤切缘阳性患者，若术后病理为基底切缘阳性、未分化组织学类型、粘膜下浸润，提示肿瘤残留/复发的高风险，建议追加外科手术。

Abstract: Objective: In this study, the incidence and clinicopathological characteristics of residual/recurrent tumors in patients with positive margin after Endoscopic Submucosal Dissection (ESD) of gastric carcinoma were evaluated by retrospective analysis of residual/recurrent tumors in patients with positive margin. Our analysis also looked at factors that increased the risk of residual/recurrence to avoid unnecessary surgery. Methods: We retrospectively analyzed the clinical and pathological data of 1002 patients after ESD in the Endoscopy Center of the Affiliated Hospital of Qingdao University. 58 patients with positive marginal tumors were divided into the residual/recurrent tumor group and the non-residual/recurrent tumor group. We compared the clinicopathological characteristics of the two groups. Results: 1) Surgical resection was performed in 8 of the 16 patients with residual tumor/lymph node metastases. Local recurrences were found in 2 of the 45 patients followed up at 7/21 months. The final rate of residual/recurrence including lymph node metastasis was 17.2% (10/58). 2) Statistical analysis showed that the type of surgical margin (P = 0.012), the type of tissue differentiation (P = 0.001) and the depth of invasion (P = 0.004) were significantly associated with tumor residual/recurrence. Conclusion: For patients with positive tumor margins after endoscopic submucosal dissection, additional surgery is recommended if the postoperative pathology shows positive basal margin submucosal infiltration of undifferentiated histological type, suggesting a high risk of tumor residual/recurrence.