Department of Hygiene and Epidemiology, Medical Faculty, University of Porto, Porto, Portugal.
Eur J Cancer Prev. 2011 Mar;20(2):96-101. doi: 10.1097/CEJ.0b013e3283429e77.
The coexistence of two aetiologically distinct types of cardia cancer, with distinctive histological characteristics of the neoplastic and nonneoplastic gastric mucosa, may explain the heterogeneous evidence of its association with Helicobacter pylori infection. We compared gastric cardia and noncardia cancers with regard to the frequency of H. pylori infection, the histological characteristics of the nonneoplastic gastric mucosa and the tumour histological type. We evaluated 41 cardia and 339 noncardia cancer cases undergoing gastrectomy, and 380 community controls. H. pylori infection and CagA infection status were assessed by enzyme-linked immunosorbent assay and western blot, respectively. Histological characteristics of the neoplastic and nonneoplastic mucosa were obtained from pathology reports. The association between infection and cancers with different location was quantified in a case-control analysis and cardia and noncardia cancers were further compared. No positive relation was found for H. pylori infection, but CagA-positive strains were associated with an increased risk of noncardia cancer (odds ratio=1.60, 95% confidence interval=1.17-2.18). Twenty-seven (65.8%) cardia cancer cases, predominantly of the intestinal type (66.7%), had nonneoplastic atrophic mucosa and 208 (61.4%) noncardia cancers (56.7% of the intestinal type). Among the cases occurring in nonatrophic patients, the proportion of cancers of the Laurén's intestinal type was 71.4% for cardia and 54.2% for noncardia gastric cancers. Cardia and noncardia cancers were similar with regard to the relation with infection, histological type and condition of the nonneoplastic mucosa, supporting the predominance of cardia cancers determined by H. pylori infection in this European high-risk setting.
两种病因学上不同类型的贲门癌共存，其肿瘤和非肿瘤胃黏膜具有独特的组织学特征，这可能解释了其与幽门螺杆菌感染的相关性存在异质性证据。我们比较了贲门癌和非贲门癌与幽门螺杆菌感染的频率、非肿瘤性胃黏膜的组织学特征和肿瘤组织学类型的关系。我们评估了 41 例贲门癌和 339 例非贲门癌患者行胃切除术，以及 380 例社区对照。通过酶联免疫吸附试验和 Western blot 分别评估 H. pylori 感染和 CagA 感染状态。从病理报告中获得肿瘤和非肿瘤黏膜的组织学特征。在病例对照分析中定量了感染与不同部位癌症之间的关系，并进一步比较了贲门癌和非贲门癌。未发现幽门螺杆菌感染的阳性关系，但 CagA 阳性株与非贲门癌的风险增加相关（比值比=1.60，95%置信区间=1.17-2.18）。27 例（65.8%）贲门癌病例，主要为肠型（66.7%），存在非肿瘤性萎缩性黏膜，208 例（61.4%）非贲门癌（肠型的 56.7%）。在非萎缩性患者中，贲门癌和非贲门胃癌的肠型Laurén 型癌症的比例分别为 71.4%和 54.2%。贲门癌和非贲门癌在感染、组织学类型和非肿瘤性黏膜状况方面具有相似的关系，支持在这种欧洲高危环境中，幽门螺杆菌感染决定了贲门癌的主导地位。
