Endoscopic submucosal dissection for superficial ultra-low rectal tumors: outcomes and predictive factors for procedure difficulty.

IF 3.6 3区医学 Q2 ONCOLOGY

American journal of cancer research Pub Date : 2024-12-15 eCollection Date: 2024-01-01 DOI:10.62347/PVVD6843

Yinxin Wu, Yanqin Xu, Haiyan Lin, Xiaolu Lin, Wanyin Deng, Wei Liang, Qing Lin

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引用次数: 0

Abstract

Background: Ultra-low rectal endoscopic submucosal dissection (ESD) presents technical challenges due to anatomical features. The objective of this research was to determine the risk factors linked to unsuccessful curative resections and to create a nomogram predictive model to assess the likelihood of encountering technical challenges.

Methods: Patients with ultra-low rectal tumors received ESD form June 2017 to December 2022 were retrospectively enrolled. An ESD procedure exceeding 30 min was deemed difficult. A logistic regression analysis was performed to pinpoint important factors and predictors. The effectiveness of the nomogram, which incorporated the identified predictors, was evaluated by employing receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).

Results: A total of 300 patients with ultra-low rectal tumors were enrolled, with a curative resection rate of 82.0%. Multivariate logistic regression revealed that poor lifting sign (OR = 3.282, P = 0.026), non-granular type laterally spreading tumors (LST-NG, OR = 2.230, P = 0.042) and procedure time ≥ 60 min (OR = 6.976, P = 0.010) contributed to non-curative resection. Predictors for ESD difficulty included tumor diameter ≥ 30 mm (compared with < 30 mm, 30-50 mm, OR = 2.450, P = 0.044; ≥ 50 mm, OR = 5.047, P = 0.009), ≥ 1/2 circumference involvement (OR = 3.183, P = 0.038); dentate line invasion (OR = 3.881, P = 0.026) and less colorectal ESD experience (OR = 3.415, P = 0.032). The nomogram performed well in both train and validation sets (area under the curve (AUC) = 0.873 and 0.810, respectively). Calibration plots exhibited satisfactory agreement between predicted and observed outcomes, and DCA showed superior clinical benefit of the model than individual predictors.

Conclusions: Poor lifting sign, LST-NG and procedure time ≥ 60 min were associated with non-curative resection for ultra-low rectal ESD. By including factors such as tumor size, location, and the operator's experience with ESD, the nomogram can predict the complexity of the procedure before surgery.

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内镜下粘膜下剥离术治疗浅表超低位直肠肿瘤：手术难度的预后和预测因素。

背景：超低直肠内镜下粘膜下剥离术（ESD）由于其解剖学特点，提出了技术上的挑战。本研究的目的是确定与不成功的治愈性切除相关的风险因素，并创建一个nomogram预测模型来评估遇到技术挑战的可能性。方法：回顾性纳入2017年6月至2022年12月接受ESD治疗的超低位直肠肿瘤患者。超过30分钟的ESD手术被认为是困难的。进行逻辑回归分析以确定重要因素和预测因素。采用受试者工作特征（ROC）曲线、校正图和决策曲线分析（DCA）对纳入预测因子的nomogram有效性进行评价。结果：共纳入300例超低位直肠肿瘤，治愈率为82.0%。多因素logistic回归分析显示，不能根治切除的原因为吊升体征差（OR = 3.282, P = 0.026）、非颗粒型肿瘤（LST-NG, OR = 2.230, P = 0.042）和手术时间≥60 min （OR = 6.976, P = 0.010）。ESD困难的预测因素包括肿瘤直径≥30 mm(与< 30 mm、30-50 mm相比，OR = 2.450, P = 0.044；≥50mm, OR = 5.047, P = 0.009)，≥1/2周长受累（OR = 3.183, P = 0.038）；齿状线侵犯（OR = 3.881, P = 0.026）和结肠ESD发生率较低（OR = 3.415, P = 0.032）。模态图在训练集和验证集上均表现良好（曲线下面积（AUC）分别为0.873和0.810）。校正图在预测结果和观察结果之间显示了令人满意的一致性，DCA显示了模型比单个预测因子更优越的临床效益。结论：对于超低直肠ESD患者，举升体征差、LST-NG、手术时间≥60 min与非根治性切除相关。通过包括肿瘤大小、位置和手术人员的ESD经验等因素，nomographic可以在手术前预测手术的复杂性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of cancer research ONCOLOGY-

自引率

3.80%

发文量

263

期刊介绍： The American Journal of Cancer Research (AJCR) (ISSN 2156-6976), is an independent open access, online only journal to facilitate rapid dissemination of novel discoveries in basic science and treatment of cancer. It was founded by a group of scientists for cancer research and clinical academic oncologists from around the world, who are devoted to the promotion and advancement of our understanding of the cancer and its treatment. The scope of AJCR is intended to encompass that of multi-disciplinary researchers from any scientific discipline where the primary focus of the research is to increase and integrate knowledge about etiology and molecular mechanisms of carcinogenesis with the ultimate aim of advancing the cure and prevention of this increasingly devastating disease. To achieve these aims AJCR will publish review articles, original articles and new techniques in cancer research and therapy. It will also publish hypothesis, case reports and letter to the editor. Unlike most other open access online journals, AJCR will keep most of the traditional features of paper print that we are all familiar with, such as continuous volume, issue numbers, as well as continuous page numbers to retain our comfortable familiarity towards an academic journal.