早期胃癌分化程度与临床特征的关系研究

Correlation analysis between clinical characteristics and differentiation of early gastric cancer

摘要:

目的 研究早期胃癌分化程度与临床特征的关系，为临床制订早期胃癌的治疗方案提供更准确的理论依据。方法 回顾性分析2018年5月1日—2022年12月31日于山西医科大学第一医院行内镜黏膜下剥离术（ESD）或外科手术后经病理确诊为早期胃癌的143例患者的临床资料。根据病理组织分化程度分为分化型组112例和未分化型组31例。比较两组患者的性别、年龄、身高、体重、体质量指数（BMI）、吸烟史、饮酒史、肿瘤位置、肿瘤大小、大体形态、色调变化、浸润深度、合并溃疡、脉管浸润、淋巴结转移、萎缩、中性粒细胞计数、淋巴细胞计数、血小板计数、中性粒细胞与淋巴细胞比值（NLR）、血小板计数与淋巴细胞比值（PLR）；采用多因素一般Logistic回归分析早期胃癌分化程度的影响因素；绘制受试者工作特征（ROC）曲线分析相关因素对未分化型早期胃癌发生的预测效能。结果 分化型组与未分化型组患者的年龄、色调变化、浸润深度、合并溃疡、淋巴结转移、血小板计数和NLR比较，差异均有统计学意义（P <0.05）；两组患者的性别、身高、体重、BMI、吸烟史、饮酒史、肿瘤位置、肿瘤大小、大体形态、脉管浸润、萎缩、中性粒细胞计数、淋巴细胞计数和PLR比较，差异均无统计学意义（P >0.05）。多因素一般Logistic回归分析结果显示：年龄大［O^R =0.928（95% CI：0.879，0.980）］是早期胃癌未分化的保护因素（P <0.05）；肿瘤色调发白［O^R =10.747（95% CI：2.325，49.686）］、浸润深度深［O^R =7.259（95% CI：2.241，23.512）］、合并溃疡［O^R =4.463（95% CI：1.201，16.589）］、淋巴结转移［O^R =9.346 （95% CI：2.144，40.732）］是未分化型早期胃癌的危险因素（P <0.05）。ROC曲线分析结果显示，浸润深度为黏膜下层的曲线下面积（AUC）为0.674（95% CI：0.566，0.781），敏感性为67.7%（95% CI：0.486，0.833），特异性为67.0%（95% CI：0.574，0.756）；合并溃疡的AUC为0.677（95% CI：0.579，0.774），敏感性为87.1%（95% CI：0.701，0.963），特异性为48.2%（95% CI： 0.387，0.579）。提示肿瘤浸润深度达黏膜下层、合并溃疡可作为未分化型早期胃癌发生的预测指标；年龄、色调变化、淋巴结转移无预测价值。结论 早期胃癌分化程度主要与年龄、色调变化、浸润深度、合并溃疡、淋巴结转移有关；年龄大是未分化型早期胃癌的保护因素，肿瘤色调发白、浸润深度深、合并溃疡、淋巴结转移是未分化型早期胃癌的独立危险因素；肿瘤浸润深度达黏膜下层、合并溃疡可作为未分化型早期胃癌发生的预测指标。

Abstract:

Objective To investigate the relationship between the differentiation degree of early gastric cancer and clinical characteristics, providing a more accurate theoretical basis for the clinical treatment of early gastric cancer.Methods A retrospective analysis of the clinical data of 143 patients diagnosed with early gastric cancer through pathological confirmation after endoscopic submucosal dissection (ESD) or surgery at the First Hospital of Shanxi Medical University from May 1, 2018, to December 31, 2022. According to the degree of pathological tissue differentiation, the patients were divided into a differentiated group (112 cases) and an undifferentiated group (31 cases). Gender, age, height, body weight, body mass index (BMI), smoking history, alcohol consumption history, tumor location, tumor size, gross morphology, color change, depth of invasion, ulceration, vascular invasion, lymph node metastasis, atrophy, neutrophil count, lymphocyte count, platelet count, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were compared between the two groups. Multivariate logistic regression analysis was used to analyze the influencing factors of the differentiation degree of early gastric cancer. The receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of related factors on undifferentiated early gastric cancer occurrence.Results There were statistically significant differences (P < 0.05) in age, color change, depth of invasion, ulceration, lymph node metastasis, platelet count, and NLR between the differentiated and undifferentiated groups of patients. There were no statistically significant differences (P > 0.05) in gender, height, body weight, BMI, smoking history, alcohol consumption history, tumor location, tumor size, gross morphology, vascular invasion, atrophy, neutrophil count, lymphocyte count, and PLR between the two groups. The results of multivariate logistic regression analysis showed that older age [O^R = 0.928 (95% CI: 0.879, 0.980) ] was a protective factor for undifferentiated early gastric cancer (P < 0.05). Tumor color change to whitish [O^R = 10.747 (95% CI: 2.325, 49.686) ], deeper invasion [O^R = 7.259 (95% CI: 2.241, 23.512) ], ulceration [O^R = 4.463 (95% CI: 1.201, 16.589) ], and lymph node metastasis [OR = 9.346 (95% CI: 2.144, 40.732) ] were risk factors for undifferentiated early gastric cancer (P < 0.05). The ROC curve results showed that when the tumor invaded the submucosal layer, the area under the curve (AUC) was 0.674 (95% CI: 0.566, 0.781), with a sensitivity of 67.7% (95% CI: 0.486, 0.833) and specificity of 67.0% (95% CI: 0.574, 0.756). When ulceration was present, the AUC was 0.677 (95% CI: 0.579, 0.774), with a sensitivity of 87.1% (95% CI: 0.701, 0.963) and specificity of 48.2% (95% CI: 0.387, 0.579). This suggests that tumor invasion into the submucosal layer and the presence of ulceration can serve as predictive indicators for undifferentiated early gastric cancer, while age, color change, and lymph node metastasis have no predictive value.Conclusion The degree of differentiation of early gastric cancer is mainly related to age, color change, depth of invasion, ulceration, and lymph node metastasis. Older age is a protective factor for undifferentiated early gastric cancer, while tumor color change to whitish, deeper invasion, ulceration, and lymph node metastasis are independent risk factors for undifferentiated early gastric cancer. Tumor invasion into the submucosal layer and the presence of ulceration can serve as predictive indicators for undifferentiated early gastric cancer.