术中黏膜下层血管密度与术后IL-6动态监测对食管早癌ESD术后狭窄的预测价值OA

Objective To investigate the predictive value of intraoperative submucosal vascular density and postoperative dynamic monitoring of interleukin-6(IL-6)for stenosis after endoscopic submucosal dissection(ESD)in early esophageal cancer.Methods The clinical data of 376 patients with early esophageal cancer who underwent ESD surgery in Luoyang Central Hospital from September 2021 to September 2024 were retrospectively analyzed.Submucosal vascular density,IL-6 levels at 1 d and 5 d after operation were counted and analyzed;the difference of IL-6 between 1 d and 5 d after operation(postoperative ΔIL-6)was calculated.The incidence rate of stricture after ESD in patients with different vascular density and IL-6 levels was compared.Multivariate Logistic regression analysis was used to explore the influencing factors of stricture after ESD in early esophageal cancer,and the predictive efficacy of each index on stricture after ESD in early esophageal cancer was evaluated by receiver operating characteristic(ROC)curve.Results The submucosa vascular density in 376 patients with early esophageal cancer was(37.57±7.96)mm-2,and the levels of IL-6 at 1 d and 5 d after operation were(4.12±0.92)ng·mL-1 and(3.31±1.15)ng·mL-1 respectively,and the postoperative ΔIL-6 was(0.81±0.10)ng·mL-1.Within three months after ESD,the incidence rate of stenosis after ESD in the 376 patients was 19.15%(72/376).The incidence rates of stenosis in the high submucosa vascular density group and the high IL-6 group(1 d and 5 d after operation)were higher than those in the corresponding low level groups(P<0.05),while the incidence rate of stenosis in the high ΔIL-6 group was lower than that in the low ΔIL-6 group(P<0.05).The proportion of lesions with longitudinal length≥40 mm,lesion infiltration depth of M3+SM1,lesion circumference≥3/4 and muscularis propria injury in the stenosis group were higher than those in the non-stenosis group(P<0.05).Multivariate Logistic regression analysis showed that high intraoperative submucosa vascular density,high IL-6 at 1 d and 5 d after operation,lesion longitudinal length≥40 mm,lesion infiltration depth M3+SM1,lesion circumference≥3/4 and muscularis propria injury were risk factors for stricture after ESD in early esophageal cancer(P<0.05),while high postoperative ΔIL-6 was a protective factor(P<0.05).ROC curve analysis showed that the sensitivity(95.83%)and area under the curve(0.946)of intraoperative submucosa vascular density combined with postoperative ΔIL-6 in predicting postoperative stenosis after ESD in early esophageal cancer were higher than those of single prediction(P<0.05),while the specificity of combined prediction(90.79%)was similar to that of single prediction.Conclusion Intraoperative submucosal vascular density and postoperative IL-6 level are risk factors for postoperative stenosis after ESD in early esophageal cancer,and both of them can effectively predict postoperative stenosis,and the combined prediction has higher clinical value.