一项多中心回顾性研究：胃低度上皮内瘤变病理升级的危险因素和列线图构建
A multicenter retrospective study: risk factors and nomogram construction for pathological escalation of gastric low-grade intraepithelial neoplasia.
摘要(中文译文)
低级别上皮内瘤变（LGIN）被认为是胃癌的癌前病变。然而，初始活检结果与内镜黏膜下剥离术（ESD）术后组织病理学结果之间存在差异。本研究旨在开发并临床验证一种多因素列线图，用于预测胃LGIN病理升级的风险。我们回顾性分析了2018年6月至2024年7月期间在三家医院接受胃ESD治疗的患者的临床数据。来自浙江省中医院的68例患者和来自浙江省人民医院的15例患者构成训练队列；来自绍兴市人民医院的68例患者构成验证队列。我们对13项基线患者特征进行了详细比较，并进行了logistic回归分析。随后，开发并评估了列线图。病理升级率为54.1%。独立危险因素包括男性、混合型IIc病变形态、边界清晰、病变大小≥15 mm以及幽门螺杆菌抗体阳性。训练队列的受试者工作特征曲线下面积（AUC）为0.891，灵敏度为0.882，特异度为0.592，表明具有良好的判别能力。校准曲线与对角线高度吻合，提示预测准确性优良。DCA显示具有显著的临床获益。所构建的列线图在验证队列中的预测性能为中等，AUC约为0.67。这项多中心回顾性研究确定了LGIN病理升级为高级别上皮内瘤变（HGIN）或胃癌的几个独立危险因素，包括混合型病变形态、边界清晰和病变大小≥15 mm。需要进一步的前瞻性研究来验证该列线图在不同临床环境中的性能。
Abstract
Low-grade intraepithelial neoplasia (LGIN) is recognized as a precancerous lesion of gastric carcinoma. However, discrepancies have been observed between initial biopsy findings and post-Endoscopic Submucosal Dissection (ESD) histopathological results. This study aims to develop and clinically validate a multifactorial nomogram for predicting the risk of pathological upgrading in gastric LGIN. We retrospectively analyzed clinical data from patients who underwent gastric ESD at three hospitals from June 2018 to July 2024. Sixty-eight patients from Zhejiang Provincial Hospital of Chinese Medicine and fifteen patients from Zhejiang Provincial People's Hospital constituted the training cohort; sixty-eight patients from Shaoxing People's Hospital formed the validation cohort. We performed detailed comparisons of 13 baseline patient characteristics and conducted logistic regression analyses. Subsequently, a nomogram was developed and evaluated. The pathological upgrade rate was 54.1%. Independent risk factors included male sex, mixed IIc lesion morphology, clear demarcation lines, lesion size ≥ 15 mm, and Helicobacter pylori antibody positivity. The area under the receiver operating characteristic curve (AUC) of the training cohort was 0.891, with a sensitivity of 0.882 and specificity of 0.592, indicating strong discriminative ability. The calibration curve closely aligned with the diagonal, suggesting excellent predictive accuracy. DCA indicated significant clinical benefit. The predictive performance of the constructed nomogram in the validation cohort is moderate, with an AUC of approximately 0.67. This multicenter retrospective study identified several independent risk factors for pathological escalation of LGIN to high-grade intraepithelial neoplasia (HGIN) or gastric cancer, including mixed lesion morphology, clear demarcation lines, and lesion size ≥ 15 mm. Further prospective studies are warranted to validate the nomogram's performance across diverse clinical settings.
如何引用
AMA
Di-Yun Shen, Shun-Hai Zhou, Chao-Yi Shi, Xuan-Ran Chen, Yu-Zhen Bi, Xue-Man Wang, et al. A multicenter retrospective study: risk factors and nomogram construction for pathological escalation of gastric low-grade intraepithelial neoplasia.. Frontiers in medicine. 2026; doi:10.3389/fmed.2026.1800141.
APA
Di-Yun Shen, Shun-Hai Zhou, Chao-Yi Shi, Xuan-Ran Chen, Yu-Zhen Bi, Xue-Man Wang, et al (2026). A multicenter retrospective study: risk factors and nomogram construction for pathological escalation of gastric low-grade intraepithelial neoplasia.. Frontiers in medicine. https://doi.org/10.3389/fmed.2026.1800141
GB/T 7714
Di-Yun Shen, Shun-Hai Zhou, Chao-Yi Shi, Xuan-Ran Chen, Yu-Zhen Bi, Xue-Man Wang, et al. A multicenter retrospective study: risk factors and nomogram construction for pathological escalation of gastric low-grade intraepithelial neoplasia.[J]. Frontiers in medicine, 2026 doi:10.3389/fmed.2026.1800141.
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