食管早期癌及癌前病变内镜黏膜下剥离术后新发病灶的临床特征分析

Clinical characteristics of newly‑developed lesions of early esophageal cancer and precancerous lesions after endoscopic submucosal dissection

摘要:

目的 总结食管早期癌及癌前病变内镜黏膜下剥离术（endoscopic submucosal dissection ，ESD）后新发病灶的临床特征，探讨发生异时性多原发食管早期癌的危险因素。方法 回顾性分析2018年1月至2020年1月泰州市人民医院消化科行食管ESD的311例患者的临床资料及术后随访结果，统计新发病灶的发生率及发生间隔，分析异时性多原发食管癌的危险因素。结果 311例患者中1例（0.3%）出现局部复发，2例（0.6%）为同时性多原发食管早期癌，27例（8.7%）为异时性多原发食管早期癌。多因素回归分析显示病灶长度（OR=5.728，95%CI：0.959~34.208，P<0.001）、斑点状分布的卢戈液不染区（Lugol‑voiding lesions，LVLs）（OR=6.574，95%CI：2.163~19.977，P<0.001）、中性粒细胞‑淋巴细胞比值（neutrophil‑to‑lymphocyte ratio，NLR）（OR=3.72，95%CI：2.144~6.452，P<0.001）与异时性多原发食管癌的发生相关。结论 长病灶、斑点状分布的LVLs、高NLR的患者异时性多发食管癌发病率升高，对于存在上述危险因素的患者需密切随访。

Abstract:

Objective To summarize the clinical characteristics of newly‑developed lesions of early esophageal cancer and precancerous lesions after endoscopic submucosal dissection (ESD) , and to investigate the risk factors associated with metachronous multiple primary early esophageal cancers. Methods A retrospective analysis was conducted on clinical data and postoperative follow‑up results of 311 patients who underwent esophageal ESD at the Department of Gastroenterology, Taizhou People""s Hospital, from January 2018 to January 2020. The incidence and interval of newly‑developed lesions were documented, and the risk factors for metachronous multiple primary esophageal cancers were identified. Results Among the 311 patients, 1 case (0.3%) experienced local recurrence, 2 patients (0.6%) had synchronous multiple primary early esophageal cancers, and 27 cases (8.7%) had metachronous multiple primary early esophageal cancers. Multivariate regression analysis showed that lesion length (OR=5.728, 95%CI: 0.959‑34.208, P<0.001), Lugol‑voiding lesions (LVLs) with speckled distribution (OR=6.574, 95%CI: 2.163‑19.977, P<0.001), and high neutrophil‑to‑lymphocyte ratio (NLR) (OR=3.72, 95%CI: 2.144‑6.452, P<0.001) were independent risk factors for metachronous multiple primary early esophageal cancers. Conclusion Incidence of metachronous multiple primary early esophageal cancers is elevated in patients with long lesions, LVLs exhibiting speckled distribution, and high NLR. Therefore, close follow‑up is essential for patients displaying these identified risk factors.