结直肠侧向发育型肿瘤癌变的内镜学特征

Endoscopic characteristics associated with malignancy in colorectal laterally spreading tumors

摘要:

目的 探讨结直肠侧向发育型肿瘤（laterally spreading tumor，LST）癌变的独立预测因素。方法 回顾性收集于2013年6月—2019年3月在首都医科大学附属北京友谊医院因结直肠LST行内镜治疗患者的性别、年龄、体重指数、吸烟史、病变的内镜学特征和病理学特点。用单因素分析寻找癌变的影响因素，对于其中差异有统计学意义的因素再纳入多因素Logistic回归分析。结果 共纳入了323例患者341处病变。假凹陷型LST的癌变率最高[85.48%（53/62）]，其次为结节混合型[76.97%（117/152）]，均显著高于颗粒均一型[29.51%（18/61），P均＜0.001]和扁平隆起型[24.24%（16/66），P均＜0.001]。单因素分析显示，假凹陷型（P＜0.001，OR=18.40，95%CI：7.46～45.42）、结节混合型（P＜0.001，OR=10.45，95%CI：5.30～20.58）、位于直乙部位（P＜0.001，OR=2.33，95%CI：1.47～3.69）、直径≥2 cm（P＜0.001，OR=2.60，95%CI：1.60～4.00）是病变发生癌变的危险因素。多因素Logistic回归分析表明，假凹陷型（P＜0.001，OR=17.51，95%CI：7.06～43.43）、结节混合型（P＜0.001，OR=8.25，95%CI：4.07～16.73）、直径≥2 cm（P=0.032，OR=1.80，95%CI：1.05～3.08）是结直肠LST发生癌变的独立预测因素。结论 当LST为假凹陷型、结节混合型或直径≥2 cm时病变发生癌变的风险高，需要采取整块切除的方式治疗。

Abstract:

Objective To investigate the independent predictors for malignancy in colorectal laterally spreading tumors (LSTs) by therapeutic endoscopy. Methods Data of consecutive patients with colorectal LSTs who underwent endoscopic treatment in Beijing Friendship Hospital between June 2013 and March 2019 were collected for retrospective analysis. Patients' gender, age, body mass index, smoking history, and endoscopic and histological results were reviewed. Univariate analysis was used to identify the associated factors for malignancy of colorectal LSTs. Factors with statistical significance in univariate analysis were used in multivariate logistic regression to determine the independent predictors. Results A total of 323 patients with 341 colorectal LSTs were involved in the study. The rate of malignancy was highest in non-granular pseudo depressed (NG-PD) subtype [85.48% (53/62)], followed by granular nodular mixed (G-NM) subtype [76.97% (117/152)]. Both of the above rates were significantly higher than that of granular homogenous (G-H) subtype [29.51% (18/61), P<0.001] and non-granular flat elevated (NG-FE) subtype [24.24% (16/66), P<0.001]. Univariate analysis showed that NG-PD subtype (P<0.001, OR=18.40, 95%CI: 7.46-45.42), G-NM subtype (P<0.001, OR=10.45, 95%CI: 5.30-20.58), rectosigmoid location (P<0.001, OR=2.33, 95%CI: 1.47-3.69) and size ≥2 cm (P<0.001, OR=2.60, 95%CI: 1.60-4.00) associated with malignancy for colorectal LSTs. In multivariate logistic regression, NG-PD subtype (P<0.001, OR=17.51, 95%CI: 7.06-43.43), G-NM subtype (P<0.001, OR=8.25, 95%CI: 4.07-16.73) and size ≥2 cm (P=0.032, OR=1.80, 95%CI: 1.05-3.08) remained to be independent predictors. Conclusion LSTs of NG-PD subtype, G-NM subtype or size ≥2 cm are high risk factors of malignancy, in which cases, en bloc resection is required.