早期胃癌ESD擴(kuò)大適應(yīng)癥淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)分析課件

ESD擴(kuò)大適應(yīng)癥與胃癌轉(zhuǎn)移風(fēng)險(xiǎn)ESD擴(kuò)大適應(yīng)癥與胃癌轉(zhuǎn)移風(fēng)險(xiǎn)1早期胃癌ESD擴(kuò)大適應(yīng)證(1)直徑>2cm,分化型,pT1a,UL(-);(2)直徑≤2cm,分化型,pT1a,UL(+);(3)直徑≤2cm,未分化型,pT1a,UL(-);早期胃癌ESD擴(kuò)大適應(yīng)證2概念浸潤深度潰Zem表3早期胃癌內(nèi)鏡下切除適應(yīng)證漫潤深度責(zé)系LL(+)TIb[s11)時國擴(kuò)大適應(yīng)證病變非適應(yīng)證病變注:ela(M):術(shù)前診斷為黏膜內(nèi)癌;nh《s):術(shù)前診斷為黏膜下癌;tL:潰病形成注;eTla(M)術(shù)前診斷為黏膜內(nèi)癌:ch(SM)術(shù)前診斷為黏膜下癌:UL:漬形成《痕),不再限定病變2015年日本消化器內(nèi)視鏡學(xué)會《早期癌內(nèi)鏡早期胃癌內(nèi)鏡下規(guī)范化切除的專家黏膜切除術(shù)和黏膜下剝離術(shù)治療指南》解讀共識意見(2018,北京)本次講述指南以日本指南為準(zhǔn)概念3早期胃癌ESD擴(kuò)大適應(yīng)癥淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)分析課件4早期胃癌ESD淋巴結(jié)轉(zhuǎn)移率當(dāng)無脈管轉(zhuǎn)移時,文獻(xiàn)報(bào)道淋巴結(jié)轉(zhuǎn)移率的情況如下:·(1)直徑>3cm,分化型為主,pT1a,UL(+)的病灶約為(2)直徑>3cm,分化型為主,pT1b(SM1)的病灶約為26%(3)直徑>2cm,未分化型為主,pT1a,UL(-)的病灶約為28%(4)未分化型為主,pT1a,UL(+)的病灶約為5.1%(5)未分化型為主,pT1b(SM1)的病灶約為106%日本2015《早期胃癌內(nèi)鏡黏膜切除術(shù)和黏膜下剝離術(shù)治療指早期胃癌ESD淋巴結(jié)轉(zhuǎn)移率5TheprognosticfactorsforEGCincludedepthoftumorinvasion,LNmetastasis,gradeofhistologicdifferentiation,andcurativesurgeryandmanystudieshavereportedthatLNmetastasisisthemostimportantfactorMGCrecurrenceTheprognosticfactorsforEGC6lable1.ReLationshipbetweenclinicopathologicfactorsandlymphnoderin1,191casesofmucosalgastriccanceralefemale23:19(54.8:45.2714:4352.137903336432(143:9.5762)1園26269916422860.0)0oa8Laminapropriamuscularismuco537011.908.1}439:71019261123100286:714)64:5651508492nparticular,theLNmetastasis-positivegrouphadyoungerage(Pasiondepth(muscularismucosainvasion,P<0.001),largertumorsize(P0.002),morefrequentulcerationonpreoperativeendoscopy(P=0.01),morediffusLaurenclassification(P=0.005),andmoreundifferentiatedtype(P0.001)lable1.ReLationshipbetween7esofriskfactorsforlnmetastasisinmgcTable2.Univariateandmultivariateanalysesofriskfactorsformucosalgastriccancer(logistianalysis;P<0.10)UnivariateanalysisnalysisPathologicfactorP-value95%CIOddsratioP-valueOddsratio1.005-3.595Laminapropriavs.muscularisL.785-11.734.575877-12.833Tumorsize,s2cmvs>2am1.175-5.5830.2151.189-4.1522.2220.036Differentiatedys.undifferentiated0.0011.619-7.1990.0251.196-14.9874.23ClconfidenceintervalP<0.001),tumorsize>2cm(P=0.asperLaurenclassification(P=0.005),andundifferentiated-typehistologywereassociatedwithLNmetastasisin982),andundifferentiated-typenMGCesofriskfactorsforlnmeta8巴=?路%o)hadextendedindicationsforESD(Fig3,Table3).Furthermore,amongthecasesofMGCinvadingthemuscularispenetrat5.0%巴=9ReviewofLNmetastasis-positivecaseswithindicationsforESDTable3.Incidenceoflymphnodemetastasisinmucosalgastriccancer:thepresentandreassessmentofthecriteriaforendoscopicsubmucosaldissectionCriteriaPresentAdifferentiated-lypeadenocarcinornawithoutulcerativefindings(UL(-)whereinthedepthofinvasionis1/179(0.6%uicallydiagnosedasTlaandthetumordiameteriss23m236(1,1%)b)differentiated-type,UL(+),ands]cmindiameter2n01020%)(c)undifferentiated-typeand<?cmindiameter4156(2.6%Adifferentiated-typeadenocarcinomawithoutulcerativefindings(UL(-))whereinthecpthofinvasionis07200%)linicallydiagnosedasTlawithintheLaminapropria)andtheturmordiauasTlawithinthelaminapropria)and.Hbut>2cmindiambidiffcrentialed-type,UL(.),ands3cmindiameler(c)undifferentiated-type,UL(-)ands2cmindiameter1/103(1.0%)ReviewofLNmetastasis-positi10早期胃癌ESD擴(kuò)大適應(yīng)癥淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)分析課件11早期胃癌ESD擴(kuò)大適應(yīng)癥淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)分析課件12早期胃癌ESD擴(kuò)大適應(yīng)癥淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)分析課件13早期胃癌ESD擴(kuò)大適應(yīng)癥淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)分析課件14早期胃癌ESD擴(kuò)大適應(yīng)癥淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)分析課件15早期胃癌ESD擴(kuò)大適應(yīng)癥淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)分析課件16早期胃癌ESD擴(kuò)大適應(yīng)癥淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)分析課件17早期胃癌ESD擴(kuò)大適應(yīng)癥淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)分析課件18早期胃癌ESD擴(kuò)大適應(yīng)癥淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)分析課件19早期胃癌ESD擴(kuò)大適應(yīng)癥淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)分析課件20早期胃癌ESD擴(kuò)大適應(yīng)癥淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)分析課件21早期胃癌ESD擴(kuò)大適應(yīng)癥淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)分析課件22早期胃癌ESD擴(kuò)大適應(yīng)癥淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)分析課件