目的:胃低级别上皮内瘤变(LGIN)的临床结果表现出显著的多样性,而目前对内镜活检诊断的依赖在为本病设计合适的治疗策略方面存在局限性.本研究旨在建立胃LGIN的预后预测评分系统(e-Cout系统),为解决这一临床挑战提供了理论基础。
方法:回顾性选择2000-2022年在我院消化内镜中心进行上消化道内镜检查的30余例患者中符合纳入和排除标准的1013例,其中484例为发展队列,529例为验证队列。采用相关统计分析,我们使用发展队列数据来建立胃LGIN的e-Cout系统,并进一步使用验证队列数据进行内部验证。
结果:在发育阶段,基于一致的回归系数,我们为预后不良的六个危险因素分配了点值:微血管(MV)畸变4分,MV增厚3分,溃疡2分,病灶大小>2cm各1点,病程>1年,病变表面充血和发红。然后将患者分为四个风险级别:低风险(0-1分),中等风险(2-3),高风险(4-6),风险很高(≥7)。在验证阶段,在所有风险水平中观察到胃LGIN的三种不同结局存在显著差异.逆转和进展的概率显着下降和上升,分别,随着风险水平的上升,差异有统计学意义(P<0.001)。
结论:提出的e-Cout系统有望帮助临床医生预测胃LGIN患者不同临床结局的概率和风险水平。该系统有望为该疾病的临床策略选择提供改进的基础和指导。
The clinical outcomes of gastric low-grade intraepithelial neoplasia (LGIN) exhibit significant diversity, and the current reliance on endoscopic biopsy for diagnosis poses limitations in devising appropriate treatment strategies for this disease. This study aims to establish a prognostic prediction scoring system (e-Cout system) for gastric LGIN, offering a theoretical foundation for solving this clinical challenge.
Retrospectively selecting 1013 cases meeting the inclusion and exclusion criteria from over 300,000 cases of upper gastrointestinal endoscopy performed at the Digestive Endoscopy Center of our hospital between 2000 and 2022, the cohort included 484 cases as development cohort and 529 cases for validation. Employing relevant statistical analysis, we used development cohort data to establish the e-Cout system for gastric LGIN, and further used validation cohort data to for internal validation.
In the developmental stage, based on accordant regression coefficients, we assigned point values to six risk factors for poor prognosis: 4 points for microvessel (MV) distortion, 3 points for MV thickening, 2 points for ulcer, and 1 point each for lesion size > 2cm, disease duration > 1 year, and hyperemia and redness on the lesion surface. Patients were then categorized into four risk levels: low risk (0-1 point), medium risk (2-3), high risk (4-6), and very high risk (≥7). During the validation stage, significant differences in the three different outcomes of gastric LGIN were observed across all risk levels. The probability of reversal and progression showed a significant decrease and increase, respectively, with escalating of risk levels, and these differences were statistically significant (P< 0.001).
The proposed e-Cout system holds promise in aiding clinicians to predict the probability and risk levels of different clinical outcomes in patients with gastric LGIN. This system is expected to provide an improved foundation and guidance for the selection of clinical strategies for this disease.