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何度, 吴霞, 江丹等. 130例内镜下黏膜切除浅表型食管癌及食管上皮内肿瘤的病理学分析[J]. 四川大学学报(医学版), 2015, 46(6): 911-915.
引用本文: 何度, 吴霞, 江丹等. 130例内镜下黏膜切除浅表型食管癌及食管上皮内肿瘤的病理学分析[J]. 四川大学学报(医学版), 2015, 46(6): 911-915.
HE Du, WU Xia, JIANG Dan. et al. Superficial Esophageal Carcinoma and Esophageal Intraepithelial Neoplasia: a Pathological Study of 130 Cases[J]. Journal of Sichuan University (Medical Sciences), 2015, 46(6): 911-915.
Citation: HE Du, WU Xia, JIANG Dan. et al. Superficial Esophageal Carcinoma and Esophageal Intraepithelial Neoplasia: a Pathological Study of 130 Cases[J]. Journal of Sichuan University (Medical Sciences), 2015, 46(6): 911-915.

130例内镜下黏膜切除浅表型食管癌及食管上皮内肿瘤的病理学分析

Superficial Esophageal Carcinoma and Esophageal Intraepithelial Neoplasia: a Pathological Study of 130 Cases

  • 摘要: 目的 探讨治疗性内镜黏膜下切除(ESD)浅表型食管癌及食管上皮内肿瘤的病理特征。方法 收集四川大学华西医院ESD切除的浅表型食管癌及食管上皮内肿瘤130例患者基本资料并随访。进行病变的肉眼分型、组织学类型分型、病变大小测量、浸润深度判定,评判浅表型浸润癌的浸润性生长方式、有无出芽、有无脉管侵犯,评判切缘状态等病理特征并进行统计分析。结果 患者年龄平均60.4岁,中位年龄62岁。肉眼分型以混合型(78例,60.0%)居多,其次为浅表平坦型(Type 0-Ⅱ)(49例, 37.7%)。病变最长径平均16.5 mm,中位病变最长径为13.8 mm。组织学改变:不确定异型增生3例(2.3%)、低级别上皮内肿瘤25例(19.2%)、高级别上皮内肿瘤56例(43.1%)、浸润性癌46例(35.4%)。肉眼分型与组织学亚型不相关。浸润性癌均为鳞状细胞癌,黏膜内浸润癌和黏膜下浸润癌分别为40例(87.0%)和6例(13.0%),黏膜下层浸润深度为sm1和sm2者分别为2例(4.3%)和4例(8.7%)。46例浸润性癌的浸润生长方式(INF)分别为INFa(膨胀型)23例(50.0%)、INFb(中间型)17例(37.0%)和INFc(浸润型)6例(13.0%)。3例(6.5%)可见肿瘤出芽;2例(4.3%)见脉管侵犯。切缘阳性30例(23.1%),低级别、高级别上皮内肿瘤和浸润性癌的切缘阳性率分别为4.0%(1/25)、8.9%(5/56)和52.1%(24/46),差异有统计学意义( P<0.001)。3种浸润癌生长方式的切缘阳性率差异没有统计学意义( P=0.208)。15例(11.5%)复发,10例呈低级别上皮内肿瘤,5例呈高级别上皮内肿瘤。低级别、高级别上皮内肿瘤和浸润性癌的复发率分别为8.0%(2/25)、8.9%(5/56)和17.4%(8/46),差异有统计学意义( P<0.05)。切缘阳性与阴性比较,复发率差异没有统计学意义〔10.0%(3/30) vs. 12.0%(12/100), P=0.590〕。结论 ESD切除的浅表型食管癌及食管上皮内肿瘤中以混合型肉眼亚型居多,病理组织学改变以高级别上皮内肿瘤和浸润性癌为主。ESD完整切除率较高,浸润性癌较上皮内肿瘤易复发且更易出现切缘阳性,但切缘阳性者无易于复发的倾向。

     

    Abstract: Objective To investigate the clinicopathologic characteristics of superficial adenocarcinoma of esophagogastric junction (AEG), and to analyze the relationship between endoscopic macroscopic type and tumor depth for such cancers. Methods The clinical data of the 57 superficial AEG patients who underwent endoscopic resection or surgical operation between November 2008 and May 2015 in West China Hospital, Sichuan University were analyzed. Clinicopathologic features were compared between different depth of tumor invasion by univariate and multivariate analysis. Results The age ranged between 48 and 76 yr., with an average age of (63.0±6.8) yr.; 49 cases in male, 8 cases in female. The tumor size ranged between 3.0 and 40.0 mm,the average size was 16.6 mm. The mucosal carcinoma was 28 cases, the submucosal carcinoma is 29 cases. There were no significant differences in age, gender, histological type and Siewert type in two groups, while there was statistical difference in tumor diameter ( P=0.02) and endoscopic typing ( P=0.02) between the two groups. The further multivariate analysis revealed that endoscopic macroscopic type ( P=0.041) was an independent risk factor of superficial AEG invasion depth. The risk of submucosal invasion was 3.244 times in depressed type as large as in elevated or flat type of the superficial AEG (95% confidence interval: 1.050-10.023). Conclusion The endoscopic macroscopic type may be useful in accurately diagnosing superficial AEG invasion depth. For the endoscopic macroscopic type mainly of depression, especially the type 0-Ⅲ, which was more likely to infiltrate the submucosal and more likely to have lymph node metastasis, do not recommend to get an endoscopic treatment.

     

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