早期胃癌ESD扩大适应症淋巴结转移风险分析课件

ESD扩大适应症与胃癌转移风险ESD扩大适应症与胃癌转移风险1早期胃癌ESD扩大适应证(1)直径>2cm,分化型,pT1a,UL(-);(2)直径≤2cm,分化型,pT1a,UL(+);(3)直径≤2cm,未分化型,pT1a,UL(-);早期胃癌ESD扩大适应证2概念浸润深度溃Zem表3早期胃癌内镜下切除适应证漫润深度责系LL(+)TIb[s11)时国扩大适应证病变非适应证病变注:ela(M):术前诊断为黏膜内癌;nh《s):术前诊断为黏膜下癌;tL:溃病形成注;eTla(M)术前诊断为黏膜内癌:ch(SM)术前诊断为黏膜下癌:UL:渍形成《痕),不再限定病变2015年日本消化器内视镜学会《早期癌内镜早期胃癌内镜下规范化切除的专家黏膜切除术和黏膜下剥离术治疗指南》解读共识意见(2018,北京)本次讲述指南以日本指南为准概念3早期胃癌ESD扩大适应症淋巴结转移风险分析课件4早期胃癌ESD淋巴结转移率当无脉管转移时,文献报道淋巴结转移率的情况如下:·(1)直径>3cm,分化型为主,pT1a,UL(+)的病灶约为(2)直径>3cm,分化型为主,pT1b(SM1)的病灶约为26%(3)直径>2cm,未分化型为主,pT1a,UL(-)的病灶约为28%(4)未分化型为主,pT1a,UL(+)的病灶约为5.1%(5)未分化型为主,pT1b(SM1)的病灶约为106%日本2015《早期胃癌内镜黏膜切除术和黏膜下剥离术治疗指早期胃癌ESD淋巴结转移率5TheprognosticfactorsforEGCincludedepthoftumorinvasion,LNmetastasis,gradeofhistologicdifferentiation,andcurativesurgeryandmanystudieshavereportedthatLNmetastasisisthemostimportantfactorMGCrecurrenceTheprognosticfactorsforEGC6lable1.ReLationshipbetweenclinicopathologicfactorsandlymphnoderin1,191casesofmucosalgastriccanceralefemale23:19(54.8:45.2714:4352.137903336432(143:9.5762)1园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扩大适应症淋巴结转移风险分析课件11早期胃癌ESD扩大适应症淋巴结转移风险分析课件12早期胃癌ESD扩大适应症淋巴结转移风险分析课件13早期胃癌ESD扩大适应症淋巴结转移风险分析课件14早期胃癌ESD扩大适应症淋巴结转移风险分析课件15早期胃癌ESD扩大适应症淋巴结转移风险分析课件16早期胃癌ESD扩大适应症淋巴结转移风险分析课件17早期胃癌ESD扩大适应症淋巴结转移风险分析课件18早期胃癌ESD扩大适应症淋巴结转移风险分析课件19早期胃癌ESD扩大适应症淋巴结转移风险分析课件20早期胃癌ESD扩大适应症淋巴结转移风险分析课件21早期胃癌ESD扩大适应症淋巴结转移风险分析课件22早期胃癌ESD扩大适应症淋巴结转移风险分析课件23早期胃癌ESD扩大适应症淋巴结转移风险分析课件24早期胃癌ESD扩大适应症淋巴结转移风险分析课件25早期胃癌ESD扩大适应症淋巴结转移风险分析课件26早期胃癌ESD扩大适应症淋巴结转移风险分析课件27早期胃癌ESD扩大适应症淋巴结转移风险分析课件28早期胃癌ESD扩大适应症淋巴结转移风险分析课件29早期胃癌ESD扩大适应症淋巴结转移风险分析课件30ESD扩大适应症与胃癌转移风险ESD扩大适应症与胃癌转移风险31早期胃癌ESD扩大适应证(1)直径>2cm,分化型,pT1a,UL(-);(2)直径≤2cm,分化型,pT1a,UL(+);(3)直径≤2cm,未分化型,pT1a,UL(-);早期胃癌ESD扩大适应证32概念浸润深度溃Zem表3早期胃癌内镜下切除适应证漫润深度责系LL(+)TIb[s11)时国扩大适应证病变非适应证病变注:ela(M):术前诊断为黏膜内癌;nh《s):术前诊断为黏膜下癌;tL:溃病形成注;eTla(M)术前诊断为黏膜内癌:ch(SM)术前诊断为黏膜下癌:UL:渍形成《痕),不再限定病变2015年日本消化器内视镜学会《早期癌内镜早期胃癌内镜下规范化切除的专家黏膜切除术和黏膜下剥离术治疗指南》解读共识意见(2018,北京)本次讲述指南以日本指南为准概念33早期胃癌ESD扩大适应症淋巴结转移风险分析课件34早期胃癌ESD淋巴结转移率当无脉管转移时,文献报道淋巴结转移率的情况如下:·(1)直径>3cm,分化型为主,pT1a,UL(+)的病灶约为(2)直径>3cm,分化型为主,pT1b(SM1)的病灶约为26%(3)直径>2cm,未分化型为主,pT1a,UL(-)的病灶约为28%(4)未分化型为主,pT1a,UL(+)的病灶约为5.1%(5)未分化型为主,pT1b(SM1)的病灶约为106%日本2015《早期胃癌内镜黏膜切除术和黏膜下剥离术治疗指早期胃癌ESD淋巴结转移率35TheprognosticfactorsforEGCincludedepthoftumorinvasion,LNmetastasis,gradeofhistologicdifferentiation,andcurativesurgeryandmanystudieshavereportedthatLNmetastasisisthemostimportantfactorMGCrecurrenceTheprognosticfactorsforEGC36lable1.ReLationshipbetweenclinicopathologicfactorsandlymphnoderin1,191casesofmucosalgastriccanceralefemale23:19(54.8:45.2714:4352.137903336432(143:9.5762)1园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.ReLationshipbetween37esofriskfactorsforlnmetastasisinmgcTable2.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-typenMGCesofriskfactorsforlnmeta38巴=?路%o)hadextendedindicationsforESD(Fig3,Table3).Furthermore,amongthecasesofMGCinvadingthemuscularispenetrat5.0%巴=39ReviewofLNmetastasis-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)