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在早期胃癌中,术前评估和最终病理学标准之间的差异
Mo-Yi-Ge Jize1,2, Wei Wu1,2, Shi-Gang Ding1,2
1Department of Gastroenterology, Peking University Third Hospital, Beijing 100083, China.
World journal of gastrointestinal oncology
|January 29, 2026
概括
对于早期胃癌 (EGC) 治疗的准确选择至关重要. 日本的指导方针显示,预测内镜下粘膜切割 (ESD) 或胃切除术的准确率为74.4%,瘤位置和组织学影响差异.
科学领域:
- 胃肠病学 胃肠病学
- 在瘤学瘤学.
- 手术病理学手术病理学
背景情况:
- 对于早期胃癌 (EGC) 治疗的不适当的患者选择,如内镜下粘膜剖析 (ESD) 或胃切除术,可能导致非治愈的切除或过度治疗.
- 评估日本指南与EGC病理标准之间的一致性对于优化治疗策略至关重要.
- 在非日本人群中评估指导方针的适用性旨在在全球范围内完善内镜治疗标准.
研究的目的:
- 通过比较术前的治疗指示与术后的病理标准来评估EGC临床决策的准确性.
- 根据指导方针,确定导致计划和实际EGC治疗之间的差异的因素.
主要方法:
- 从2010年1月到2022年12月的796个EGC案件的回顾性分析.
- 将病例分类为同样估计的,低估的 (ESD指示与外科标准) 和高估的 (外科指示与ESD标准) 组.
- 多变量分析以确定与治疗指示差异相关的风险因素.
主要成果:
- 对于ESD和胃切除指示的术前评估准确率分别为73.0%和76.0%,整体差异率为25.6%.
- 上三分之一的胃瘤位置 (OR=2.158) 与低估有关,而无差异组织学 (OR=2.005) 预测过高估计.
- 在术前和术后评估之间,在瘤直径,透深度,性发现和组织学方面注意到了显著的差异.
结论:
- 术前EGC治疗指示的整体准确性为74.4%.
- 胃上三分之一的瘤位置和未差异化的组织学是差异的关键预测因素.
- 上部三分之一的瘤往往被低估,而无差异化的瘤则容易被高估,因此需要仔细考虑这些因素.
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