胃炎评估操作链接与肠上皮化生评估操作链接。
Operative link for gastritis assessment vs operative link on intestinal metaplasia assessment.
机构信息
Surgical Pathology and Cytopathology Unit, Department of Diagnostic Medical Sciences and Special Therapies, University of Padova, 35100 Padova, Italy.
出版信息
World J Gastroenterol. 2011 Nov 7;17(41):4596-601. doi: 10.3748/wjg.v17.i41.4596.
AIM
To compare the reliability of gastritis staging systems in ranking gastritis-associated cancer risk in a large series of consecutive patients.
METHODS
Gastric mucosal atrophy is the precancerous condition in which intestinal-type gastric cancer (GC) most frequently develops. The operative link for gastritis assessment (OLGA) staging system ranks the GC risk according to both the topography and the severity of gastric atrophy (as assessed histologically on the basis of the Sydney protocol for gastric mucosal biopsy). Both cross-sectional and long-term follow-up trials have consistently associated OLGA stages III-IV with a higher risk of GC. A recently-proposed modification of the OLGA staging system (OLGIM) basically incorporates the OLGA frame, but replaces the atrophy score with an assessment of intestinal metaplasia (IM) alone. A series of 4552 consecutive biopsy sets (2007-2009) was retrieved and reassessed according to both the OLGA and the OLGIM staging systems. A set of at least 5 biopsy samples was available for all the cases considered.
RESULTS
In 4460 of 4552 cases (98.0%), both the high-risk stages (III + IV) and the low-risk stages (0 +I + II) were assessed applying the OLGA and OLGIM criteria. Among the 243 OLGA high-risk stages, 14 (5.8%) were down-staged to a low risk using OLGIM. The 67 (1.5%) incidentally-found neoplastic lesions (intraepithelial or invasive) were consistently associated with high-risk stages, as assessed by both OLGA and OLGIM (P < 0.001 for both). Two of 34 intestinal-type GCs coexisting with a high-risk OLGA stage (stage III) were associated with a low-risk OLGIM stage (stage II).
CONCLUSION
Gastritis staging systems (both OLGA and OLGIM) convey prognostically important information on the gastritis-associated cancer risk. Because of its clinical impact, the stage of gastritis should be included as a conclusive message in the gastritis histology report. Since it focuses on IM alone, OLGIM staging is less sensitive than OLGA staging in the identification of patients at high risk of gastric cancer.
目的
比较胃炎分级系统在评估大量连续患者胃炎相关癌症风险方面的可靠性。
方法
胃黏膜萎缩是肠型胃癌（GC）最常发生的癌前病变。胃炎评估的操作链接（OLGA）分期系统根据胃萎缩的部位和严重程度（根据悉尼胃黏膜活检协议进行组织学评估）来评估 GC 风险。横断面和长期随访试验一致表明，OLGA 分期 III-IV 与 GC 风险较高相关。最近提出的 OLGA 分期系统（OLGIM）的修改版基本上采用了 OLGA 框架，但用肠化生（IM）评估代替了萎缩评分。检索并重新评估了 4552 例连续活检组（2007-2009 年），这些活检组分别采用 OLGA 和 OLGIM 分期系统进行评估。所有考虑的病例都至少有 5 个活检样本。
结果
在 4552 例中的 4460 例（98.0%）中，OLGA 和 OLGIM 标准都评估了高风险阶段（III+IV）和低风险阶段（0+I+II）。在 243 例 OLGA 高风险阶段中，14 例（5.8%）用 OLGIM 降为低风险。67 例（1.5%）偶然发现的肿瘤病变（上皮内或侵袭性）与 OLGA 和 OLGIM 评估的高风险阶段均相关（两者均 P<0.001）。在 34 例肠型 GC 中，有 2 例与高风险 OLGA 阶段（III 期）共存，与低风险 OLGIM 阶段（II 期）相关。
结论
胃炎分级系统（OLGA 和 OLGIM）提供了关于胃炎相关癌症风险的预后重要信息。由于其临床影响，胃炎的分期应作为胃炎组织学报告的一个结论性信息。由于其重点是 IM 本身，OLGIM 分期在识别胃癌高危患者方面不如 OLGA 分期敏感。
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