普通白光联合窄带光成像放大内镜检查诊断早期胃癌浸润深度的模型研究

A model of predicting infiltration depth of early gastric cancers based on conventional white light endoscopy and magnifying endoscopy with narrow band imaging findings

摘要:

目的 分析早期胃癌（EGC）黏膜下浸润的特征表现，通过联合白光内镜及窄带光成像结合放大内镜（ME-NBI）检查提高EGC浸润深度诊断的准确性。方法 回顾性分析2015年1月至2017年12月期间因术前怀疑EGC于北京友谊医院行内镜黏膜下剥离术或外科手术治疗的患者资料。收集患者基本信息、病灶特征及术后病理等信息，分析EGC黏膜下浸润的特征、黏膜下浸润的独立危险因素，构建预测EGC浸润深度的模型。结果 195例患者(207处病灶)纳入研究。207例病灶以2∶1比例随机分为建模组（138处）及测试组（69处）。在建模组，病灶位于胃上1/3（OR=12.949,95%CI：2.148~78.070,P=0.005），胃中1/3（OR=7.534,95%CI：1.044~54.360,P=0.045），病灶长径＞2 cm（OR=6.828,95%CI：1.657~28.136,P=0.008）及存在扩张血管（OR=6.856,95%CI：1.577~29.805,P=0.010)是病灶黏膜下浸润的独立危险因素。根据上述独立危险因素构建浸润深度预测评分系统（DPSS）（病灶位于胃上1/3、病灶位于胃中1/3、病灶长径＞2 cm、存在扩张血管各为5分、4分、4分、4分）。在建模组及测试组，DPSS预测病灶黏膜下浸润的受试者工作特征曲线下面积分别为0.884（95%CI：0.809~0.960)及0.799（95%CI：0.684~0.914)。界值为8分时，建模组及测试组诊断敏感度分别为83.3%、71.4%，特异度分别为76.2%、74.5%。结论 联合普通白光内镜及ME-NBI建立的DPSS可以较好地预测EGC浸润深度。

Abstract:

Objective To analyze the characteristics of early gastric cancer (EGC) with submucosal infiltration under conventional white light endoscopy (C-WLE) and magnifying endoscopy with narrow band imaging （ME-NBI）, and to improve the diagnostic accuracy of EGC infiltration by combining C-WLE and ME-NBI findings. Methods Data of patients who received endoscopic submucosal dissection or surgical treatment for EGC at Beijing Friendship Hospital from January 2015 to December 2017 were retrospectively analyzed. The basic information, lesion characteristics, and postoperative pathology of patients were collected. The characteristics of EGC with submucosal infiltration were analyzed, and a model for predicting the depth of EGC invasion was constructed by combining independent risk factors of submucosal infiltration. Results A total of 207 lesions in 195 patients were included in the study, divided into the modeling group (138 lesions) and the testing group (69 lesions) in the ratio 2∶1. In the modeling group, the lesions located in the upper third of the stomach (OR=12.949, 95%CI: 2.148-78.070, P=0.005), middle third of the stomach (OR=7.534, 95%CI: 1.044-54.360, P=0.045), >2 cm in size (OR=6.828, 95%CI: 1.657-28.136, P=0.008) and presence of dilated blood vessel (OR=6.856, 95%CI: 1.577-29.805, P=0.010) were independent risk factors for submucosal infiltration. Based on the above independent risk factors, the infiltration depth predicting scoring system (DPSS) was constructed (5 points for the lesion located in upper third of the stomach, 4 points for the lesions located in the middle third of stomach, 4 points for lesions >2 cm in size, and 4 points for the presence of dilated vessels). The areas under the receiver operating characteristic curve for predicting the infiltration depth of DPSS were 0.884 (95%CI: 0.809-0.960) in the modeling group and 0.799 (95%CI: 0.684-0.914) in the testing group. The sensitivities of the modeling group and the testing group were 83.3% and 71.4% respectively; and the specificities were 76.2% and 74.5%, respectively in the two groups at 8 as the cut-off score. Conclusion The DPSS based on C-WLE and ME-NBI findings can predict the invasion depth of EGC.