应该如何治疗食道的超大Lugol未染色的病变? 来自基于人口的队列研究的结果
Mengfei Liu1, Zifan Qi1, Ren Zhou1
1State Key Laboratory of Molecular Oncology, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, China.
Cancer medicine
|September 21, 2023
概括
消化道中的大型Lugol未染色病变 (LULs) 显著增加了严重发育不良及以上发育不良 (SDA) 的风险. 超过20毫米的病变需要共享治疗或密集监测的决策,而16-20毫米的病变需要密集监测.
科学领域:
- 胃肠病学 胃肠病学
- 在瘤学瘤学.
- 内镜检查是指内镜检查.
背景情况:
- 目前对食道皮表皮病变的指导方针侧重于严重的发育不良及以上 (SDA).
- 通过活检进行的组织病理学诊断可能会低估病变的严重程度.
- 在内镜查中,Lugol-unstained病变 (LULs) 是一个关键指标.
研究的目的:
- 评估SDA的累积风险与Lugol未染色病变 (LULs) 的大小相关.
- 为了确定LUL大小是否是SDA的预测因素,独立于初始活检结果.
主要方法:
- 基于人口的查试验对1073名参与者的分析.
- 评估Lugol不染病变 (LUL) 尺寸在基线染色内镜.
- 多变量后勤回归用于评估SDA的累积风险,平均为7年.
主要成果:
- 发现了146例SDA病例.
- 较大的LUL与较高的SDA累积风险显著相关 (累积发病率>20mm:76.92%).
- 调整后的几率比率表明,与≤5mm病变相比,LULs 16-20mm (OR=21.02) 和>20mm (OR=33.62) 的SDA风险要高得多.
结论:
- 建议医生与患者共享决策LUL>20mm,不论组织学.
- 应考虑对16-20mm的LUL进行密集监测.
- 腹腔皮细胞的大小是评估食道状细胞瘤风险的关键因素.
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