| ?Background? The esophageal cancer with a high morbidity in China,the most major histological type is squamous cell carcinoma.Endoscopic submucosal dissection(ESD)has gained acceptance as the first line treatment option for superficial esophageal squmous cell carcinoma(SESCC)patients.However,not all SESCC patients are appropriate for ESD.The invasion depth is the decisive factor whether a lesion achieve radical resection in post-ESD or not.The correlation between tumor invasion depth and risk of lymph node metastasis has been suggested in cases of early stage esophageal cancer.Therefore,the preoperative precise evaluation of the depth of invasion is crucial in SESCC patients.Note that several problems on predict invasion depth of SESCC patients remain to be work out,need to further discussion.Part one Predictive factors for influence the pre-operation diagnosis of invasion depth of SESCC?Objective? Respectively on the basis of the ESD absolute indications and relative indications as the grouping criterions,and explore the risk factors for predict invasion depth of SESCC patients before operation?Methods? A total of 128 SESCC patients who underwent ESD between January 2011 and December 2016 in our hospital were included.The clinicopathologic factors were retrospectively evaluated with univariate and multivariate logistics analysis in order to identified predictive factors for influence the diagnosis of invasion depth for SESCC patients.The sensitivity,specificity,accuracy and AUC of ROC of independent factors predicted the depth of invasion was calculated in patients.?Results? 1.When we basis on a lesion whether fit for the ESD absolute indications(M1-M2 vs.?M3)as the grouping standard: 1.1 The morphology and the changes of IPCL were the independent risk factors with P < 0.001(OR=11.679,95%CI:3.511-38.850)and P < 0.001(OR=28.780,95%CI: 6.890-120.210),respectively.However,the AVA area(OR=2.439,P=0.477,95%CI: 0.209-28.443)and the “pink-color” sign(OR=4.217,P=0.084,95%CI: 0.823-21.614)were not the independent risk factors to predicted the invasion depth for SESCC.1.2 The sensitivity,specificity,accuracy of morphology predicted the depth of invasion was 82.1%,79.5%,81.3%,respectively.The sensitivity,specificity,accuracy of the changes of IPCL predicted the depth of invasion was 78.6%,93.2%,83.6%,respectively.At the same time,the sensitivity,specificity,accuracy for combined the two independent risk factors respectively was 92.9%,72.7%,and 85.9%.1.3 The AUC of morphology predicted the depth of invasion was 0.808(95%CI: 0.729-0.873),the change of IPCL was 0.859(95%CI: 0.786-0.914),the difference was no statistically significance(P=0.332).The AUC of combined the two independent risk factors was 0.927(95%CI: 0.867-0.965),a significant higher than simply morphology(P<0.001)and the change of IPCL(P=0.012).2.When we basis on a lesion whether fit for the ESD relative indications(?SM1 vs.SM2-SM3)as the grouping standard: 2.1 The changes of IPCL was the independent risk factor with P<0.001(OR=142.159,95%CI:13.494-1497.672).However,the morphology(OR=5.118,P=0.102,95%CI:0.724-36.182)and AVA area(OR=1.933,P=0.999)were not the independent risk factors to predicted the invasion depth for SESCC.2.2 As the unique independent risk factor,the sensitivity,specificity,accuracy was 99.1%,60.0%,94.5%,and the AUC was 0.796(95%CI: 0.667-0.924),respectively.?Conclusions? 1.Whatever for the standards for ESD absolute or relative indications,the changes of IPCL was the main independent factor to infect the diagnosis of predicted the invasion depth for SESCC patients.2.Morover,predicted a lesion whether suit to ESD absolute indications,the morphology also was the independent factor except the changes of IPCL.At the same time,it would be better to evaluate a lesion whether suit to ESD absolute indications(M1-M2 vs.?M3)using both the morphology and the change of IPCL.2.Whatever for the standards for ESD absolute or relative indications,the AVA area was all not the independent factor to infect the diagnosis of predicted the invasion depth for SESCC,which state that the AVA area maybe couldn't improve the accuracy of predicted invasion depth for SESCC before operation,however,this conclusion need more clinical trials to verify.Part two The comparison of simple change of IPCL and IPCL+AVA area to predict invasion depth of SESCC?Object? The new JES classification by the Japan esophageal association put forward in 2012,have combined with the characteristics among the traditional Inoue classification and Arima classification,and simplified the description of IPCL and introduced the AVA area.We designed a prospective clinical trial,the main aim of this study was to clarify the usefulness of simply IPCL for the diagnosis of invasion depth of SESCC by compared with the IPCL+AVA area for endoscopists.?Methods? We recruited some appropriate endoscopists through online platform and randomly divided into “IPCL group” and “IPCL+AVA group” for respectively recommend related classifications.On the other hand,we collected the ME-NBI images for 40 SESCC patients,and all ME-NBI images edit blind processing.We uploaded same ME-NBI images with SESCC from our center through network platform to two groups,and collected their answers by using respective IPCL classifications to predict invasion depth for SESCC.The primary outcome was the accuracy of the endoscopists from two groups to predict invasion depth for SESCC.?Results? 1.When we basis on a lesion whether fit for the ESD absolute indications(M1-M2 vs.?M3)as the grouping standard,the overall accuracy of invasion depth tended to similar in IPCL group and IPCL+AVA group(IPCL vs.IPCL+AVA: 71.0% vs.72.4%),the difference between two groups has no statistical significance(P=0.838).At the same time,for the lesion fit for the ESD absolute indications(the invasion depth was M1-M2),the median accuracy of IPCL group was 73.2%,the IPCL+AVA group was 69.7%,the difference between two groups has no statistical significance(P=0.242);For the lesion unfit for the ESD absolute indications(the invasion depth ?M3),the median accuracy of IPCL group was 68.2%,the IPCL+AVA group was 75.7%,the difference between two groups has no statistical significance(P=0.429).2.When we basis on a lesion whether fit for the ESD relative indications(?SM1 vs.?SM2-SM3)as the grouping standard,the overall accuracy of two groups tended to similar(IPCL vs.IPCL+AVA: 81.8% vs.80.1%),the difference has no statistical significance(P=0.326).For the lesion fit for the ESD absolute indications(the invasion depth ?SM1),the median accuracy of two groups all were 88.5%,the difference between two groups has no statistical significance(P=0.999).However,for the lesion ufit for the ESD absolute indications(the invasion depth was SM2-SM3),we found the accuracy of the IPCL group was significantly superior to the IPCL+AVA group(43.7% vs.32.5%,P=0.003).3.Depend on the postoperative pathology as the gold standard for predict invasion depth of SESCC.The invasion depth can group into M1-M2,M3-SM1,SM2-SM3 three parts.For M3-SM1(IPCL vs.IPCL+AVA: 40.9% vs.49.6%,P=0.096)and the overall accuracy(IPCL vs.IPCL+AVA: 59.0% vs.58.1%,P=0.691)of two groups all had no statistical significance.?Conclusions? For endoscopists,the simple IPCL had got a very good effect to predict invasion depth of SESCC patients,the AVA area couldn't improve the accuracy of predicted the invasion depth for SESCC patients before operation,especially to the lesion of SM2-SM3. |
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