Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Arch Iran Med. 2013 Jun;16(6):343-7.
Due to a lack of clear criteria for recognizing subjects at risk of progression to gastric cancer (GC), this cohort study seeks to identify predictors of GC death in a high-risk population.
During 2000-2001, 1011 randomly selected residents of Ardabil, Iran without a history of gastrointestinal diseases, underwent upper endoscopy with targeted biopsy sampling. Until 2013, cancer mortality data were obtained using cancer and death registry data and verbal autopsy reports. Cox regression was used to estimate hazard ratios (HR).
A total of 3.95% of the participants [mean age: 53.1 ± 9.9 years, 49.8% males, and 88.2% Helicobacter pylori (H. pylori-positive)] died of GC. In the multivariate model, precancerous lesions at the beginning of follow-up were associated with increased GC mortality. The HR [95% confidence interval (CI)] was 7.4 (1.6-33.8) for atrophic gastritis (AG) and 23.6 (5.5-102.3) for intestinal metaplasia (IM). Age over 50 (HR = 4.4; 1.3-14.2), family history of GC (HR = 6.8; 3.3-13.8), smoking (HR = 7.4; 3.2-17.3), and endoscopically confirmed gastric ulcer (GU, HR = 6.5; 2.5-16.4) were independently associated with GC mortality. The concomitant presence of a precancerous lesion increased the HR to 46.5 (10.8-198.6) for a family history of GC, 27.6 (6.5-116.4) for smoking, and 25.1 (6.3-105.3) for age >50 years.
In this population with a high rate of H. pylori infection, age over 50 years, smoking, family history of GC, IM, AG, and in particular, an undiagnosed GU were significant independent risk factors for mortality due to GC. The assessment of a combination of these risk factors might identify individuals at risk of GC who could possibly benefit from regular surveillance.
由于缺乏明确的标准来识别进展为胃癌（GC）风险的患者，本队列研究旨在确定高危人群中 GC 死亡的预测因素。
在 2000-2001 年，伊朗阿尔达比勒随机选择 1011 名无胃肠道疾病史的居民进行上内窥镜检查和靶向活检采样。直至 2013 年，通过癌症和死亡登记数据以及死因推断报告获得癌症死亡数据。使用 Cox 回归估计风险比（HR）。
共有 3.95%的参与者[平均年龄：53.1±9.9 岁，49.8%为男性，88.2%为幽门螺杆菌（H. pylori）阳性]死于 GC。在多变量模型中，随访开始时的癌前病变与 GC 死亡率增加相关。风险比（95%置信区间（CI））为萎缩性胃炎（AG）的 7.4（1.6-33.8）和肠上皮化生（IM）的 23.6（5.5-102.3）。年龄超过 50 岁（HR=4.4；1.3-14.2）、GC 家族史（HR=6.8；3.3-13.8）、吸烟（HR=7.4；3.2-17.3）和内镜证实的胃溃疡（GU，HR=6.5；2.5-16.4）与 GC 死亡率独立相关。癌前病变的同时存在使 GC 家族史的 HR 增加到 46.5（10.8-198.6），吸烟的 HR 增加到 27.6（6.5-116.4），年龄超过 50 岁的 HR 增加到 25.1（6.3-105.3）。
在 H. pylori 感染率较高的人群中，年龄超过 50 岁、吸烟、GC 家族史、IM、AG，特别是未诊断的 GU 是 GC 死亡的显著独立危险因素。评估这些危险因素的组合可能会识别出有 GC 风险的个体，他们可能会受益于定期监测。
