Rugge M, Cassaro M, Di Mario F, Leo G, Leandro G, Russo V M, Pennelli G, Farinati F
Department of Oncological and Surgical Sciences, III Cattedra di Anatomia Patologica, Università degli Studi di Padova-Azienda Ospedale Padova, Italia.
Gut. 2003 Aug;52(8):1111-6. doi: 10.1136/gut.52.8.1111.
The cancer risk associated with gastric non-invasive neoplasia (formerly dysplasia) is debated. This prospective long term follow up study investigates the clinicopathological behaviour of non-invasive gastric neoplasia (and related lesions), focusing on the cancer risk associated with each different histological phenotype.
A total of 118 consecutive cases (nine indefinite for non- invasive neoplasia; 90 low grade non-invasive neoplasia; 16 high grade non- invasive neoplasia; and three suspicious for invasive adenocarcinoma) with a histological follow up of more than 12 months (average 52 months; range 12-206) were prospectively followed up with a standardised protocol. Patients in whom gastric cancer was detected within 12 months from the initial diagnosis of non-invasive neoplasia were excluded, assuming that invasive carcinoma had been missed at the initial endoscopy procedure.
Non-invasive neoplasia was no longer detectable in 57/118 cases (48%), was unchanged in 32 (30%), and evolved into gastric cancer in 20 patients (17%). Evolution to invasive adenocarcinoma was documented in both low and high grade non-invasive neoplastic lesions (8/90 low grade; 11/16 high grade) and correlated with histological severity (low versus high grade) at baseline (p<0.001). Seventy five per cent of cancers occurring during the long term follow up were stage I.
The risk of invasive gastric cancer increases with the histological grade of the non-invasive neoplasia. Following up non-invasive gastric neoplasia increases the likelihood of gastric cancer being detected in its early stages.
与胃非侵袭性肿瘤（原发育异常）相关的癌症风险存在争议。这项前瞻性长期随访研究调查了非侵袭性胃肿瘤（及相关病变）的临床病理行为，重点关注与每种不同组织学表型相关的癌症风险。
共有118例连续病例（9例非侵袭性肿瘤不确定；90例低级别非侵袭性肿瘤；16例高级别非侵袭性肿瘤；3例疑似侵袭性腺癌）接受了组织学随访，随访时间超过12个月（平均52个月；范围12 - 206个月），采用标准化方案进行前瞻性随访。从非侵袭性肿瘤初始诊断起12个月内检测出胃癌的患者被排除，假定初始内镜检查时漏诊了侵袭性癌。
118例病例中有57例（48%）非侵袭性肿瘤不再可检测到，32例（30%）无变化，20例患者（17%）进展为胃癌。低级别和高级别非侵袭性肿瘤病变均有进展为侵袭性腺癌的记录（低级别90例中有8例；高级别16例中有11例），且与基线时的组织学严重程度（低级别与高级别）相关（p<0.001）。长期随访期间发生的癌症中，75%为I期。
侵袭性胃癌的风险随非侵袭性肿瘤的组织学分级增加而升高。对非侵袭性胃肿瘤进行随访可增加早期发现胃癌的可能性。
