Nitta Toshikatsu, Egashira Yutaro, Akutagawa Hiroshi, Edagawa Go, Kurisu Yoshitaka, Nomura Eiji, Tanigawa Nobuhiko, Shibayama Yuro
Department of Pathology, Osaka Medical College, Osaka, Japan.
Gastric Cancer. 2009;12(1):23-30. doi: 10.1007/s10120-008-0493-4. Epub 2009 Apr 24.
Multiple gastric carcinomas often arise in gastric mucosa with chronic gastritis, particularly severe intestinal metaplasia. In regard to such characteristics, several clinicopathological risk factors for multiple carcinomas have been reported, but no clinically useful criteria are available at present for assessing the onset of multiple gastric carcinomas. If the risk for multiple gastric carcinomas could be accurately assessed, efficient and accurate surveillance could be performed following minimally invasive therapies.
In the present study, we investigated clinicopathological differences between 94 cases of multiple early gastric carcinomas and 285 cases of solitary early gastric carcinoma. We tested 379 specimens of gastric carcinomas that had been surgically resected at the Department of General and Gastroenterological Surgery of Osaka Medical College, Japan, from April 1999 to December 2006.
Univariate analysis of clinicopathological factors in the present study showed that multiple gastric carcinomas were significantly correlated to old age (> or =65 years), well- and moderately differentiated histological type, mucin phenotype (intestinal type), distribution of atrophic mucosa in the stomach (severe), degree of intestinal metaplasia in the surrounding mucosa (severe), and heterotopic glandular cysts. Multivariate analysis using the stepwise method identified age (> or =65 years) and degree of intestinal metaplasia in the surrounding mucosa (severe) as significant independent risk factors for multiple gastric carcinomas.
While other studies have shown risk factors for multiple gastric carcinomas, the present study is unique in showing risk assessment criteria based on a combination of risk factors for multiple gastric carcinomas.
多原发性胃癌常发生于伴有慢性胃炎尤其是重度肠化生的胃黏膜。关于这些特征，已有多项多原发性胃癌的临床病理危险因素报道，但目前尚无评估多原发性胃癌发病的临床实用标准。如果能够准确评估多原发性胃癌的风险，那么在微创治疗后就可以进行高效且准确的监测。
在本研究中，我们调查了94例多原发性早期胃癌与285例单发早期胃癌之间的临床病理差异。我们检测了1999年4月至2006年12月期间在日本大阪医科大学普通外科和胃肠外科手术切除的379例胃癌标本。
本研究对临床病理因素进行的单因素分析显示，多原发性胃癌与老年（≥65岁）、高分化和中分化组织学类型、黏液表型（肠型）、胃萎缩黏膜分布（重度）、周围黏膜肠化生程度（重度）以及异位腺囊肿显著相关。采用逐步法进行的多因素分析确定年龄（≥65岁）和周围黏膜肠化生程度（重度）是多原发性胃癌的显著独立危险因素。
虽然其他研究已经显示了多原发性胃癌的危险因素，但本研究独特之处在于展示了基于多原发性胃癌危险因素组合的风险评估标准。
