Lansdown M, Quirke P, Dixon M F, Axon A T, Johnston D
University Department of Surgery, General Infirmary, Leeds.
Gut. 1990 Sep;31(9):977-83. doi: 10.1136/gut.31.9.977.
The natural history of gastric epithelial dysplasia and its relation to gastric cancer are ill defined. A consecutive series of 40 patients with an initial diagnosis of gastric epithelial dysplasia based on examination of endoscopic biopsies has been reviewed to determine the clinical outcome and to evaluate a two tier histological grading system as a predictor of the risk of cancer. On review, only 20 of the 40 patients were considered to have true dysplasia: seven patients had low grade dysplasia and 13 had high grade dysplasia. Of the 13 patients with high grade dysplasia, 11 (85%) were found to have gastric cancer within 15 months. Of the 10 patients with high grade dysplasia who underwent gastrectomy, six were found to have early gastric cancer, three had cancer invading into the muscularis propria, and none had lymph node metastases. High grade dysplasia is thus a marker of gastric cancer. Moreover, the cancers associated with high grade dysplasia are usually pathologically favourable and curable. The finding, by an experienced pathologist, of high grade dysplasia in two separate sets of endoscopic biopsies is therefore an indication for radical surgical treatment, provided that the patient's age and general condition permit such an approach.
胃上皮发育异常的自然病程及其与胃癌的关系尚不明确。对连续40例经内镜活检初诊为胃上皮发育异常的患者进行了回顾性研究，以确定临床结局，并评估一种两级组织学分级系统作为癌症风险预测指标的价值。复查发现，40例患者中仅20例被认为存在真正的发育异常：7例为低级别发育异常，13例为高级别发育异常。13例高级别发育异常患者中，11例（85%）在15个月内被发现患有胃癌。10例行胃切除术的高级别发育异常患者中，6例被发现患有早期胃癌，3例癌症侵犯至固有肌层，无一例有淋巴结转移。因此，高级别发育异常是胃癌的一个标志物。此外，与高级别发育异常相关的癌症在病理上通常预后良好且可治愈。因此，如果患者年龄和一般状况允许，经验丰富的病理学家在内镜活检的两组切片中均发现高级别发育异常，即表明应采取根治性手术治疗。
