Fang Cheng, Huang Qin, Lu Lin, Shi Jiong, Sun Qi, Xu Gui Fang, Gold Jason, Mashimo Hiroshi, Zou Xiao Ping
Department of Gastroenterology, The Affiliated Drum Tower Clinical Medical School, Nanjing Medical University, Nanjing, Jiangsu Province, China.
Department of Pathology, The Affiliated Drum Tower Hospital of Nanjing University, Nanjing, Jiangsu Province, China.
J Dig Dis. 2015 Jun;16(6):327-36. doi: 10.1111/1751-2980.12240.
The incidence of proximal gastric carcinoma (PGC) is rising worldwide for unknown reasons. Herein we compare the risk factors of early PGC with distal gastric carcinoma (DGC) in patients treated at a single tertiary hospital in China.
Risk factors of 379 consecutive surgically resected early gastric carcinoma (EGC) diagnosed according to the 2010 World Health Organization criteria were studied by reviewing their medical records and esophagogastroduodenoscopy/biopsy findings and interviewing patients and family members for the patients' history of environmental toxin exposure (ETE), dietary habits, family (FCH) and personal cancer history (PCH) and survival. Differences between PGC (n = 115), DGC (n = 264) and age-matched and gender-matched controls (n = 225) were compared.
Proportion of early PGC in all EGC patients was increased significantly (P < 0.05). The independent risk factors for both PGC and DGC identified by multivariate analysis were intake of preserved food and little fruit, and gastric mucosal intestinal metaplasia and atrophy (all P < 0.05). Advanced age (odds ratio [OR] 9.83, P < 0.01), PCH (OR 5.09, P < 0.05), a high body mass index (>24 kg/m(2) ) (OR 2.79, P < 0.01) and ETE (OR 2.31, P < 0.05) were independent risk factors for PGC, but not male gender, tobacco or alcohol abuse, hiatus hernia, gastroesophageal reflux disease or columnar-lined esophagus. In contrast, FCH (OR 2.34, P < 0.01) and Helicobacter pylori infection (OR 2.81, P < 0.001) were independent risk factors for DGC.
Independent risk factors for PGC in Chinese patients differ from those of DGC or esophageal adenocarcinoma, supporting the classification of PGC as a separate gastric carcinoma entity in the Chinese populations.
近端胃癌（PGC）的发病率在全球范围内不明原因地呈上升趋势。在此，我们比较了在中国一家三级医院接受治疗的早期PGC患者与远端胃癌（DGC）患者的危险因素。
回顾379例根据2010年世界卫生组织标准确诊的连续手术切除的早期胃癌（EGC）患者的病历、食管胃十二指肠镜检查/活检结果，并就患者的环境毒素暴露史（ETE）、饮食习惯、家族癌症史（FCH）、个人癌症史（PCH）及生存情况对患者及其家属进行访谈，研究其危险因素。比较PGC组（n = 115）、DGC组（n = 264）以及年龄和性别匹配的对照组（n = 225）之间的差异。
所有EGC患者中早期PGC的比例显著增加（P < 0.05）。多因素分析确定的PGC和DGC的独立危险因素均为腌制食品摄入、水果摄入少、胃黏膜肠化生和萎缩（均P < 0.05）。高龄（比值比[OR] 9.83，P < 0.01）、PCH（OR 5.09，P < 0.05）、高体重指数（>24 kg/m²）（OR 2.79，P < 0.01）和ETE（OR 2.31，P < 0.05）是PGC的独立危险因素，但男性性别、吸烟或酗酒、食管裂孔疝、胃食管反流病或柱状上皮化生食管不是。相比之下，FCH（OR 2.34，P < 0.01）和幽门螺杆菌感染（OR 2.81，P < 0.001）是DGC的独立危险因素。
中国患者中PGC的独立危险因素与DGC或食管腺癌不同，支持将PGC在中国人群中分类为一种单独的胃癌实体。
