Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-799, Korea.
Surg Endosc. 2009 Nov;23(11):2509-14. doi: 10.1007/s00464-009-0434-2. Epub 2009 Mar 19.
Depressed-type early gastric cancer (EGC) is known to repeat improvement and exacerbation of ulceration during its natural course, forming a "malignant cycle." However, it is difficult to observe the malignant cycle of EGC in clinical practice, and little is known about the clinicopathologic factors associated with this cycle. This study aimed to evaluate the malignant cycle of EGC and to determine the clinicopathologic factors associated with the time-dependent morphologic change of EGC.
The medical records of EGC patients treated at the Seoul National University Hospital were retrospectively reviewed with two or more comparable endoscopic photos taken between March 1999 and December 2005. The ulcer stages in EGC were classified by the gastric ulcer stage system and evaluated for time-dependent morphologic changes according to the relevant factors.
In this study, 231 cases of depressed-type EGC were evaluated. At the follow-up endoscopy after a median interval of 23 days, a change in ulcer stage was observed in 66 patients (29%), with improvement in 45 patients (20%) and exacerbation in 21 patients (9%). Of the 177 patients who demonstrated an active or healing stage, 45 (25%) showed improvement and 10 (6%) exhibited exacerbation. The multivariate analysis showed that the usage of antisecretory medications, mucosal cancer, and a longer interval between the two endoscopic examinations were the factors that had a significant association with improvement of the ulcer stage.
The malignant cycle was frequently observed in depressed-type EGC. The improvement of ulceration in EGC was time dependent and associated with the usage of antisecretory medication and the depth of invasion.
已知抑郁型早期胃癌（EGC）在其自然病程中溃疡会反复改善和恶化，形成“恶性循环”。然而，在临床实践中很难观察到 EGC 的恶性循环，并且对于与该循环相关的临床病理因素知之甚少。本研究旨在评估 EGC 的恶性循环，并确定与 EGC 形态学时间依赖性变化相关的临床病理因素。
回顾性分析了 1999 年 3 月至 2005 年 12 月期间在首尔国立大学医院接受治疗的 EGC 患者的病历，这些患者接受了两次或更多次可比的内镜照片检查。根据胃癌溃疡分期系统对 EGC 的溃疡分期进行分类，并根据相关因素评估 EGC 形态学的时间依赖性变化。
本研究共评估了 231 例抑郁型 EGC 患者。在中位间隔 23 天的随访内镜检查中，66 例患者（29%）的溃疡分期发生变化，其中 45 例（20%）改善，21 例（9%）恶化。在 177 例表现为活动期或愈合期的患者中，45 例（25%）表现为改善，10 例（6%）表现为恶化。多变量分析显示，使用抗分泌药物、黏膜癌和两次内镜检查之间的时间间隔较长是与溃疡分期改善显著相关的因素。
抑郁型 EGC 中经常观察到恶性循环。EGC 溃疡的改善是时间依赖性的，与抗分泌药物的使用和浸润深度有关。
