日本贲门早期癌：它与西方的贲门早期癌有差异吗？

Early carcinoma of the gastric cardia in Japan: is it different from that in the West?

作者信息

Okabayashi T, Gotoda T, Kondo H, Inui T, Ono H, Saito D, Yoshida S, Sasako M, Shimoda T

机构信息

Department of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital, Tokyo, Japan.

出版信息

Cancer. 2000 Dec 15;89(12):2555-9.

PMID:11135215

Abstract

BACKGROUND

The incidence of adenocarcinoma of the gastric cardia has increased recently in the West. However, in Japan, most patients with gastric carcinoma have disease that is situated in the body and the distal stomach. The objectives of this study were to compare the clinicopathologic findings of patients with early gastric carcinoma (EGC) arising at the cardia and those with carcinoma in more distal parts of the stomach, then comparing the findings with those from patients with carcinoma of the gastric cardia in the West.

METHODS

Three thousand one hundred forty-four patients with EGC who underwent surgical resection between 1962 and 1997 at the National Cancer Center Hospital in Tokyo were studied. Seventy patients with EGC at the cardia were compared with those who had lesions in the middle and lower parts of the stomach. The body mass index (BMI), smoking, and drinking were evaluated using all patients with cardia EGC and 344 patients in a matched cohort in the latter group.

RESULTS

Seventy patients had an EGC located just at the cardia, whereas 2796 patients had lesions in the lower two-thirds of the stomach. The former lesions were different from those in the distal two-thirds of the stomach: More often, they were of an elevated type (34% vs. 14%, respectively, they were histologically well differentiated in 89% (vs. 59%), and there were more submucosal tumors (53% vs. 41%). The BMI, smoking, and drinking in the two groups were not different. The incidence of Barrett esophagus and gastroesophageal reflux disease (GERD) in patients with EGC were 2. 9% (2 of 70 patients) and 5.7% (4 of 70 patients), respectively.

CONCLUSIONS

There were many significant differences in clinicopathologic characteristics between patients with carcinoma of the cardia and patients with carcinoma of the distal stomach in Japan. The incidence of early cardia carcinoma was very low in Japan, and obesity, smoking, drinking, Barrett esophagus, or GERD were not related to its occurrence, in contrast to reports in the West.

摘要

背景

近年来，西方胃贲门腺癌的发病率有所上升。然而，在日本，大多数胃癌患者的病变位于胃体和胃远端。本研究的目的是比较胃贲门部早期胃癌（EGC）患者与胃远端部位癌患者的临床病理特征，然后将这些结果与西方胃贲门癌患者的结果进行比较。

方法

对1962年至1997年期间在东京国立癌症中心医院接受手术切除的3144例EGC患者进行了研究。将70例贲门部EGC患者与胃中下部有病变的患者进行比较。使用所有贲门部EGC患者和后一组中344例匹配队列患者评估体重指数（BMI）、吸烟和饮酒情况。

结果

70例患者的EGC恰好位于贲门部，而2796例患者的病变位于胃的下三分之二。前者的病变与胃远端三分之二的病变不同：前者更常为隆起型（分别为34%和14%），组织学上高分化的比例为89%（vs.59%），黏膜下肿瘤更多（53% vs.41%）。两组的BMI、吸烟和饮酒情况无差异。EGC患者中Barrett食管和胃食管反流病（GERD）的发生率分别为2.9%（70例患者中的2例）和5.7%（70例患者中的4例）。