Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea.
Helicobacter. 2012 Oct;17(5):358-68. doi: 10.1111/j.1523-5378.2012.00958.x. Epub 2012 May 14.
Western reports have suggested that the prevalence of gastric cardia cancer (GCC) has been increasing, and indicated some differences between GCC and gastric noncardia cancer (GNCC). However, few studies have been conducted in Asia. The aims of this study were to estimate the prevalence of GCC and to evaluate differences of clinicopathologic characteristics between GCC and GNCC in South Korea.
This study was single-center case-control study. A total of 829 patients with gastric cancer and 270 controls were enrolled between 2003 and 2011. Baseline characteristics, Helicobacter pylori (H. pylori) infection status, and histologic characteristics were compared among three groups (GCC, GNCC, and control).
Sixty cases (7.2%) of gastric cancer were located in cardia. Multivariate analysis showed that male odds ratio (OR, 5.72; 95% CI, 1.72-19.07; p = .005) and cigarette smoking (OR, 5.38; 95% CI, 1.39-20.90; p = .015) were risk factors of GCC in comparison with control group, but H. pylori infection rate was not significant. In the case of GNCC, cigarette smoking (OR, 3.87; 95% CI, 1.81-8.29; p < .001), past alcohol intake (OR, 2.82; 95% CI, 1.28-6.20; p = .010), intestinal metaplasia (OR, 3.22; 95% CI, 2.00-5.17; p < .001), and H. pylori infection (OR, 3.06; 95% CI, 1.90-4.93; p < .001) were risk factors of GNCC. Gastroesophageal reflux disease symptoms were higher in the GNCC (21.2%) than control group (13.5%) (p = .008). However, in the case of GCC, they were similar between the GCC (12.7%) and control group (p = .872). According to multivariate analysis, history of H. pylori eradication (OR, 0.34; 95% CI, 0.19-0.61; p < .001) was associated with a protective effect on GNCC. GCC showed higher depth of invasion (p = .038) and frequent distant metastasis (p = .012) than GNCC.
In this referral center based study, the prevalence of GCC was 7.2% in South Korea. Risk factors and clinicopathologic characteristics for GCC and GNCC were different, supporting that the pathophysiology is different in the development of GCC and GNCC.
西方的报告表明，胃贲门癌（GCC）的患病率一直在上升，并指出了 GCC 与胃非贲门癌（GNCC）之间的一些差异。然而，亚洲的研究很少。本研究旨在评估韩国 GCC 的患病率，并评估 GCC 和 GNCC 之间临床病理特征的差异。
本研究为单中心病例对照研究。2003 年至 2011 年间共纳入 829 例胃癌患者和 270 例对照。比较三组（GCC、GNCC 和对照组）的基线特征、幽门螺杆菌（H. pylori）感染状况和组织学特征。
60 例（7.2%）胃癌位于贲门。多因素分析显示，男性优势比（OR）为 5.72（95%CI，1.72-19.07；p =.005）和吸烟（OR，5.38；95%CI，1.39-20.90；p =.015）是 GCC 与对照组相比的危险因素，但 H. pylori 感染率无显著差异。在 GNCC 病例中，吸烟（OR，3.87；95%CI，1.81-8.29；p <.001）、既往饮酒（OR，2.82；95%CI，1.28-6.20；p =.010）、肠上皮化生（OR，3.22；95%CI，2.00-5.17；p <.001）和 H. pylori 感染（OR，3.06；95%CI，1.90-4.93；p <.001）是 GNCC 的危险因素。胃食管反流病症状在 GNCC（21.2%）中高于对照组（13.5%）（p =.008）。然而，在 GCC 中，GCC（12.7%）和对照组之间的差异无统计学意义（p =.872）。多因素分析显示，H. pylori 根除史（OR，0.34；95%CI，0.19-0.61；p <.001）与 GNCC 的保护作用有关。GCC 的浸润深度（p =.038）和远处转移频率（p =.012）均高于 GNCC。
在本研究中，韩国的 GCC 患病率为 7.2%。GCC 和 GNCC 的危险因素和临床病理特征不同，这支持了在 GCC 和 GNCC 的发展过程中，其病理生理学是不同的。
