内镜超声联合传统内镜对早期胃癌浸润深度的预测及临床价值研究

Predictive and clinical value of endoscopic ultrasonography combined with conventional endoscopy for invasion depth of early gastric cancer

摘要:

目的 评估内镜超声联合传统内镜对早期胃癌浸润深度的预测价值及其对治疗决策的指导作用。 方法 2011年7月至2018年1月在宁波市第二医院经胃镜病理确诊为胃癌的患者，治疗前行传统内镜、内镜超声检查评估，对129例术后病理证实为早期胃癌的患者，评估内镜超声、传统内镜及两者联合预测早期胃癌浸润深度的敏感度、特异度、阳性预测值、阴性预测值、一致性和曲线下面积（AUC）；评估内镜超声、传统内镜单项检查及两者联合对早期胃癌临床治疗决策的准确性。 结果 对于黏膜内癌，内镜超声预测的敏感度、特异度、阳性预测值、阴性预测值、kappa值和AUC分别是75.00％、82.22％、88.73％、63.79％、0.536、 0.797；传统内镜分别为61.9％、93.33％、94.55％、56.76％、0.481、0.801；两者联合分别是85.71％、82.22％、90.00％、75.51％、0.666、0.850。对于黏膜下癌，内镜超声预测的敏感度、特异度、阳性预测值、阴性预测值、kappa值和AUC分别是51.11％、86.91％、67.65％、76.84％、0.403、0.697；传统内镜分别为57.78％、73.81％、54.17％、76.54％、0.311、0.678；两者联合分别是71.11％、90.48％、80.00％、85.39％、0.632、0.817。假设基于内镜超声、传统内镜单项检查及两者联合，129例早期胃癌患者选择合适治疗（内镜下切除或外科手术）的准确率分别是83.72％、68.22％和92.25％。 结论 在早期胃癌患者中采取内镜超声、传统内镜联合，对传统内镜评估为黏膜内癌的患者不再另行内镜超声评估，仅对传统内镜不能判定或评估为大于等于黏膜下癌的患者进行内镜超声再评估，能提高术前分辨黏膜内癌及黏膜下癌浸润的准确性，提高早期胃癌选择合适治疗决策的能力，有一定的临床意义。临床试验注册 中国临床试验注册中心，ChiCTR-DDT-13003299。

Abstract:

Objective To evaluate the value of endoscopic ultrasonography （EUS） combined with conventional endoscopy for prediction of invasion depth of early gastric cancer and its therapeutic decision-making. Methods Patients with biopsy-proven gastric cancer underwent EUS and conventional endoscopy from July 2011 to January 2018 in Ningbo No.2 Hospital. A total of 129 patients with early gastric cancer confirmed by postoperative pathology were enrolled in the study. The sensitivity， specificity， positive predictive value， negative predictive value， consistency （the value of Kappa） and area under receiver operating characteristic curve （AUC） of EUS， conventional endoscopy and combination of two methods to assess the accuracy of tumor infiltration depth were analyzed. The accuracy of therapeutic decision-making based on the EUS， conventional endoscopy and combination of two methods were assessed. Results In intramucosal cancer， the sensitivity， specificity， positive predictive value， negative predictive value， the value of Kappa and AUC of EUS were 75.00％， 82.22％， 88.73％， 63.79％， 0.536 and 0.797， respectively， and for conventional endoscopy， these statistical values were 61.9％， 93.33％， 94.55％， 56.76％， 0.481， and 0.801， respectively. For the combination of two methods， these statistical values were 85.71％， 82.22％， 90.00％， 75.51％， 0.666 and 0.850， respectively. In submucosal cancer， the sensitivity， specificity， positive predictive value， negative predictive value， the value of Kappa and AUC of EUS were 51.11％， 86.91％， 67.65％， 76.84％， 0.403 and 0.697， respectively， and for conventional endoscopy， these statistical values were 57.78％， 73.81％， 54.17％， 76.54％， 0.311 and 0.678， respectively. For the combination of two methods， these statistical values were 71.11％， 90.48％， 80.00％， 85.39％， 0.632 and 0.817， respectively. The accuracies of therapeutic decision-making of EUS， conventional endoscopy and the combination of two methods were 83.72％， 68.22％ and 92.25％， respectively. Conclusion Patients who are diagnosed as intramucosal caner by conventional endoscopy should not be recommended to undergo EUS. For those whose invasion depth is unclear， or diagnosed as submucosal cancer or deeper by conventional endoscopy， EUS should be performed for reassessment. The combination of two methods can improve the accuracy of distinguishing intramucosal and submucosal caners and therapeutic decision-making. Trial registration Chinese Clinical Trial Registry， ChiCTR-DDT-13003299.