Risk assessment chart for curability of early gastric cancer with endoscopic submucosal dissection
Risk assessment chart for curability of early gastric cancer with endoscopic submucosal dissection
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DOI：
10.1016/j.gie.2011.07.067
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发表时间：
2011-12-01
影响因子：
7.7
通讯作者：
Tanaka, Katsuaki
中科院分区：
文献类型：
--
作者：
Hirasawa, Kingo;Kokawa, Atsushi;Tanaka, Katsuaki
背景：内镜下粘膜剥离术（ESD）作为早期胃癌的一种新的治疗选择在世界范围内被引入，但治愈率预测尚未在个体基础上进行评估。目的：分析影响ESD术后早期胃癌治愈率的因素，并构建其治愈率的风险评估图。设计：单机构回顾性评价。单位：大学医院。患者：2000年6月至2010年4月，我们治疗了784例早期胃癌患者961例（平均年龄70.2岁）。干预：采用典型顺序进行ESD手术。主要观察指标：采用logistic回归分析与ESD术后可切除性（整体或分段切除）和可治愈性（治愈或不可治愈切除）相关的危险因素。利用该模型，我们构建了一个风险评估图，从患者的特征来预测不可治愈的概率。结果：ESD术后整体切除率为98.9%，根治性切除率为88.1%。造成不可治愈的ESD的重要因素是大的病变、上部位置和溃疡的发现。结合肿瘤大小、肿瘤位置和溃疡表现，预测的不可治愈概率以4种颜色表示每个风险级别（浅蓝色、蓝色、黄色和红色）。溃疡性大肿瘤（>直径30mm）的不可治愈概率最高（>= 40%）在上部（红色），而非溃疡性小肿瘤(
Background: Endoscopic submucosal dissection (ESD) was introduced worldwide as a new treatment option for early gastric cancer, but curability prediction has not been evaluated on an individual basis.Objective: To analyze factors contributing to the curability of early gastric cancer after ESD and to construct a risk assessment chart for the probability of curability.Design: Single-institution retrospective review.Setting: University hospital.Patients: From June 2000 to April 2010, we treated 961 early gastric cancers in 784 patients (mean age 70.2 years).Intervention: ESD procedures were performed using typical sequences.Main Outcome Measurements: Risk factors related to resectability (en bloc or piecemeal resection) and curability (curative or noncurative resection) after ESD were analyzed using logistic regression analysis. Using this model, we constructed a risk assessment chart to predict the probability of noncurability from patient characteristics.Results: The en bloc and curative resection rates were 98.9% and 88.1%, respectively, after ESD. Significant contributors to noncurative ESD were large lesions, upper location, and ulcer findings. Predicted noncurability probabilities were displayed in 4 colors for each risk level (light blue, blue, yellow, and red) by combining tumor size, tumor location, and ulcer findings. Probability of noncurability was highest (>= 40%) in ulcerative large tumors (>30 mm in diameter) in the upper location (red) and lowest in nonulcerative small tumors (