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目的回顾性分析内镜下切除的食管鳞状上皮病变的临床病理学特征与预后。方法收集2007~2013年接受内镜切除治疗的368例早期食管癌或癌前病变患者,分析其临床病理学特征。Kaplan-Meier法构建生存曲线,单因素和多因素Cox回归模型分析独立的预后因素。结果男性252例,女性116例,中位年龄61岁(16~84岁)。诊断为增生、上皮内瘤变低级别、上皮内瘤变高级别、上皮内癌(m1)、黏膜固有层浸润癌(m2)、黏膜肌层浸润癌(m3)、黏膜下浸润深度超过200μm(sm2)和黏膜下浸润深度不超过200μm(sm1)的病例数分别为47(12.8%)、61(16.6%)、61(16.6%)、54(14.7%)、38(10.3%)、63(17.1%)、12(3.3%)与32(8.7%)例。1年、3年和5年累积异时性食管病变发生率分别为4.1%、12.9%和32.6%。淋巴结或远处转移率在m3为1.54%,sm2为6.25%。1年、3年及5年总生存率分别为99.5%、97.3%和87.5%。sm2与非sm2患者转移率差异有显著性(P=0.021);但m3和sm2差异无显著性(P=0.252)。sm2和非sm2患者异时性食管病变发生率及生存率差异有显著性(P=0.401和P=0.634)。结论食管浅表鳞状上皮肿瘤内镜下切除是一种有效、相对安全的治疗手段,在特定的sm2患者,内镜切除依然是合适的;需要随访监测sm2患者第二原发肿瘤。
Objective To retrospectively analyze the clinicopathological features and prognosis of endoscopic esophageal squamous epithelial lesion. Methods A total of 368 patients with early esophageal cancer or precancerous lesions undergoing endoscopic resection from 2007 to 2013 were collected and analyzed for their clinicopathological features. Survival curves were constructed by Kaplan-Meier method, and independent prognostic factors were analyzed by univariate and multivariate Cox regression models. Results There were 252 males and 116 females with a median age of 61 years (ranged from 16 to 84 years). The diagnosis of hyperplasia, low grade of intraepithelial neoplasia, high grade of intraepithelial neoplasia, intraepithelial neoplasia (m1), invasive ductal carcinoma of the mucosa (m2), invasive ductal carcinoma of the mucosa (m3), depth of submucosal invasion more than 200μm sm2 and submucosal infiltration depth of no more than 200μm were smokers with 47 (12.8%), 61 (16.6%), 61 (16.6%), 54 (14.7%), 38 (10.3%), 63 17.1%), 12 (3.3%) and 32 (8.7%) cases. The incidence rates of 1-year, 3-year and 5-year cumulative esophageal lesions were 4.1%, 12.9% and 32.6%, respectively. The rate of lymph node or distant metastasis was 1.54% in m3 and 6.25% in sm2. The 1-year, 3-year and 5-year overall survival rates were 99.5%, 97.3% and 87.5%, respectively. There was a significant difference in metastasis rate between sm2 and non-sm2 patients (P = 0.021), but there was no significant difference between m3 and sm2 (P = 0.252). There were significant differences in the incidence of esophageal morbidity and survival between sm2 and non-sm2 patients (P = 0.401 and P = 0.634). Conclusion The endoscopic resection of superficial esophageal squamous cell carcinoma is an effective and relatively safe treatment. In a specific sm2 patient, endoscopic resection is still appropriate; follow-up monitoring of the second primary tumor in sm2 patients is required.