Saka Akiko, Yagi Kazuyoshi, Nimura Satoshi
Department of Gastroenterology, Niigata Prefectural Yoshida Hospital, 32-14 Daibo-cho, Yoshida, Tsubame, Niigata, 959-0242, Japan.
Department of Pathology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jyonan-ku, Fukuoka, 814-0180, Japan.
Gastric Cancer. 2016 Apr;19(2):524-530. doi: 10.1007/s10120-015-0479-y. Epub 2015 Mar 10.
Gastric cancer after successful Helicobacter pylori eradication therapy is often difficult to diagnose by endoscopy because of its indistinct borderline or lack of obviously cancerous characteristics. Furthermore, it has become evident that non-neoplastic epithelium covers cancerous areas in gastric cancer after eradication. Here, we investigated these endoscopic features and their relationship to histological findings.
We studied 24 and 47 gastric cancers in patients who had (eradication group) and had not (control group) undergone H. pylori eradication, respectively. A gastritis-like appearance revealed by conventional endoscopy was defined as a mucosal pattern with no marked difference from the surrounding non-cancerous area and that revealed by narrow-band imaging (NBI)-magnifying endoscopy (ME) as the mucosal pattern observed in H. pylori-associated atrophic gastritis. We investigated a gastritis-like appearance revealed by conventional endoscopy (A), a gastritis-like appearance at the margin (B) and within (C) the cancerous area revealed by NBI-ME, and the histological characteristics of the overlying non-neoplastic epithelium. We also evaluated the relationship between endoscopic and histological findings in the eradication group.
Endoscopy showed that features A, B and C were significantly more frequent in the eradication group (P = 0.031, P < 0.001, P < 0.001, respectively). Non-neoplastic epithelium covered more than 10 % of the cancerous area more frequently in the eradication group. In the eradication group, more than 90 % of cancers showing a gastritis-like appearance had non-neoplastic epithelium extending over 10 % of the cancerous area.
Gastric cancer after successful H. pylori eradication tends to have gastritis-like features due to non-neoplastic epithelium covering the cancerous tissue.
幽门螺杆菌根除治疗成功后发生的胃癌，由于其边界不清晰或缺乏明显的癌性特征，在内镜检查时往往难以诊断。此外，现已明确根除治疗后的胃癌中，非肿瘤性上皮覆盖癌灶区域。在此，我们研究了这些内镜特征及其与组织学结果的关系。
我们分别研究了24例接受过幽门螺杆菌根除治疗的患者（根除组）和47例未接受过该治疗的患者（对照组）的胃癌情况。传统内镜检查显示的胃炎样表现定义为与周围非癌区域无明显差异的黏膜形态，而窄带成像（NBI）-放大内镜（ME）显示的胃炎样表现定义为幽门螺杆菌相关性萎缩性胃炎中观察到的黏膜形态。我们研究了传统内镜检查显示的胃炎样表现（A）、NBI-ME显示的癌灶边缘（B）和内部（C）的胃炎样表现，以及覆盖其上的非肿瘤性上皮的组织学特征。我们还评估了根除组内镜和组织学结果之间的关系。
内镜检查显示，根除组中特征A、B和C出现的频率显著更高（分别为P = 0.031、P < 0.001、P < 0.001）。根除组中非肿瘤性上皮覆盖癌灶区域超过10%的情况更为常见。在根除组中，超过90%表现出胃炎样外观的癌症，其非肿瘤性上皮延伸超过癌灶区域的10%。
幽门螺杆菌成功根除后的胃癌，由于非肿瘤性上皮覆盖癌组织，往往具有胃炎样特征。
