Risk factors of local recurrence of gastric low-grade intraepithelial neoplasia after endoscopic argon plasma coagulation

doi:10.3877/cma.j.issn.1674-6899.2021.02.008

Abstract

Abstract:

Objective

To investigate the risk factors of local recurrence of gastric low-grade intraepithelial neoplasia(LGIN) after endoscopic argon plasma coagulation(APC).

Methods

A retrospectively study was performed on the the data of 111 lesions who preoperative biopsy pathology confirmed gastric LGIN and underwent endoscopic APC from Apr. 2013 to Sep. 2020 in the Chinese PLA General Hospital. Univariate and multivariate Cox regression analysis were performed to identify the risk factors for local recurrent.

Results

The follow-up time ranged from 1 to 83 months, with median time of 19 months. Among the 111 lesions, the total incidence of local recurrence was 19.8% (22/111). The multivariate regression analysis showed that lesion size>2 cm(HR=4.16, 95%CI: 1.62-10.68, P=0.003)was the independent risk factor of local recurrence.

Conclusions

Local recurrence cannot be ignored for gastric LGIN after endoscopic APC. For lesion size>2 cm should be alert to postoperative local recurrence, and more attention should be paid to the mucosa around the lesions during strict endoscopic follow-up.

Key words: Stomach neoplasms, Low-grade intraepithelial neoplasia, Local recurrence, Argon plasma coagulation, Risk factors

Bao Li, Ningli Chai, Xiaowei Tang, Nanjun Wang, Longsong Li, Enqiang Linghu. Risk factors of local recurrence of gastric low-grade intraepithelial neoplasia after endoscopic argon plasma coagulation[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2021, 14(02): 104-108.

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References 22

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项目		未复发组(89例)	局部复发组(22例)	P值
年龄(岁，Mean±SD)		55.2±10.4	59.9±9.3	0.055
年龄[例(%)]				0.178
	≤60岁	62(69.7)	12(54.5)
	>60岁	27(30.3)	10(45.5)
性别(例，男/女)		63/26	17/5	0.544
病变部位[例(%)]				0.703
	贲门胃底和胃体	6(6.7)	2(9.1)
	胃角和胃窦	83(93.3)	20(90.9)
内镜下形态[例(%)]				0.629
	隆起型	46(51.7)	13(59.1)
	平坦型	40(44.9)	8(36.4)
	凹陷型	3(3.4)	1(4.5)
病变大小(cm，Mean±SD)		1.1±0.5	1.6±0.6	<0.01
病变大小[例(%)]				<0.01
	≤2 cm	87(97.8)	16(72.7)
	>2 cm	2(2.2)	6(27.3)
黏膜萎缩性胃炎[例(%)]				0.020
	无	67(75.3)	11(50.0)
	有	22(24.7)	11(50.0)
幽门螺杆菌感染[例(%)]
	无	51(57.3)	9(40.9)	0.167
	有	38(42.7)	13(59.1)
胃癌手术史[例(%)]				<0.01
	无	82(92.1)	14(63.6)
	有	7(7.9)	8(36.4)
氩离子凝固术[例(%)]				0.057
	无黏膜下注射	49(55.1)	17(77.3)
	黏膜下注射	40(44.9)	5(22.7)

项目		未复发组(89例)	局部复发组(22例)	P值
年龄(岁，Mean±SD)		55.2±10.4	59.9±9.3	0.055
年龄[例(%)]				0.178
	≤60岁	62(69.7)	12(54.5)
	>60岁	27(30.3)	10(45.5)
性别(例，男/女)		63/26	17/5	0.544
病变部位[例(%)]				0.703
	贲门胃底和胃体	6(6.7)	2(9.1)
	胃角和胃窦	83(93.3)	20(90.9)
内镜下形态[例(%)]				0.629
	隆起型	46(51.7)	13(59.1)
	平坦型	40(44.9)	8(36.4)
	凹陷型	3(3.4)	1(4.5)
病变大小(cm，Mean±SD)		1.1±0.5	1.6±0.6	<0.01
病变大小[例(%)]				<0.01
	≤2 cm	87(97.8)	16(72.7)
	>2 cm	2(2.2)	6(27.3)
黏膜萎缩性胃炎[例(%)]				0.020
	无	67(75.3)	11(50.0)
	有	22(24.7)	11(50.0)
幽门螺杆菌感染[例(%)]
	无	51(57.3)	9(40.9)	0.167
	有	38(42.7)	13(59.1)
胃癌手术史[例(%)]				<0.01
	无	82(92.1)	14(63.6)
	有	7(7.9)	8(36.4)
氩离子凝固术[例(%)]				0.057
	无黏膜下注射	49(55.1)	17(77.3)
	黏膜下注射	40(44.9)	5(22.7)

病例	术后复发时间(月)	复发活检病理	处理措施
1	3	LIGN	补充APC
2	9	LIGN	射频消融
3	1	LIGN	补充APC
4^a	22	LIGN	射频消融
5^b	27	癌	ESD
6	3	LIGN	射频消融
7	38	LIGN	补充APC
8^c	26	LIGN	未治疗
9	1	LIGN	补充APC
10	1	LIGN	补充APC
11^c	3	HGIN	ESD
12^c	23	LIGN	射频消融
13	14	LIGN	补充APC
14	14	LIGN	未治疗
15^c	26	多次LIGN	ESD
16	1	LIGN	补充APC
17	2	LIGN	未治疗
18	19	LIGN	补充APC
19^c	1	LIGN	补充APC
20	55	LIGN	未治疗
21	7	LIGN	补充APC
22 c	4	HGIN	外科手术

病例	术后复发时间(月)	复发活检病理	处理措施
1	3	LIGN	补充APC
2	9	LIGN	射频消融
3	1	LIGN	补充APC
4^a	22	LIGN	射频消融
5^b	27	癌	ESD
6	3	LIGN	射频消融
7	38	LIGN	补充APC
8^c	26	LIGN	未治疗
9	1	LIGN	补充APC
10	1	LIGN	补充APC
11^c	3	HGIN	ESD
12^c	23	LIGN	射频消融
13	14	LIGN	补充APC
14	14	LIGN	未治疗
15^c	26	多次LIGN	ESD
16	1	LIGN	补充APC
17	2	LIGN	未治疗
18	19	LIGN	补充APC
19^c	1	LIGN	补充APC
20	55	LIGN	未治疗
21	7	LIGN	补充APC
22 c	4	HGIN	外科手术

项目		HR值(95%CI)	P值
性别
	女	1.00
	男	1.21(0.44~3.28)	0.71
年龄(岁)
	≤60	1.00
	>60	1.52(0.66~3.52)	0.33
病灶大小
	≤2 cm	1.00
	>2 cm	4.16(1.62~10.68)	0.003
大体形态
	隆起型	1.00
	平坦型	0.68(0.28~1.64)	0.39
	凹陷型	1.14(0.15~8.76)	0.90
病灶位置
	贲门胃底和体	1.00
	胃角和胃窦	1.22(0.28~5.27)	0.79
萎缩性炎
	无	1.00
	有	1.82(0.78~4.22)	0.16
幽门螺杆菌感染
	无	1.00
	有	1.80(0.76~4.22)	0.18
胃癌手术史
	无	1.00
	有	2.75(1.14~6.63)	0.02
APC方式
	黏膜下注射	1.00
	无黏膜下注射	2.15(0.79~5.84)	0.13

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