中性粒细胞浸润和肠上皮化生的分布与内镜黏膜下剥离术后的胃黏膜肠上皮化生相关。
Neutrophil infiltration and the distribution of intestinal metaplasia is associated with metachronous gastric cancer following endoscopic submucosal dissection.
出版信息
Can J Gastroenterol Hepatol. 2015 Aug-Sep;29(6):321-5. doi: 10.1155/2015/950734. Epub 2015 Jun 12.
BACKGROUND
Endoscopic submucosal dissection (ESD) of early gastric cancer is a minimally invasive procedure. However, the risk for metachronous cancers after successful cancer treatment remains high and the risk factors for metachronous cancers have not been elucidated.
OBJECTIVE
To evaluate the risk factors for metachronous gastric cancers after ESD with a long-term follow-up.
METHODS
A total of 155 consecutive patients (119 men, 36 women, mean age 68.9 years) were treated with ESD between September 2000 and September 2009. Biopsy specimens were obtained from the greater curvature of the antrum and middle corpus to evaluate gastric mucosal status, including Helicobacter pylori, intestinal metaplasia (IM) and neutrophil infiltration (NI) before ESD. Follow-up endoscopy after ESD was scheduled at two and six months, one year and annually thereafter. H pylori eradication was recommended when possible.
RESULTS
The median follow-up period was 4.2 years. Metachronous gastric cancers were found in 23 of 155 patients (3.5% per year). No local recurrences were observed. The cumulative incidence of metachronous gastric cancer was significantly high in IM and NI in the corpus (P=0.0093 and P=0.0025, respectively [log-rank test]). The ORs for IM and NI in the corpus were 2.65 and 3.06, respectively, according to the Cox proportional hazards model (P=0.024 and P=0.0091, respectively).
CONCLUSIONS
The presence of IM and NI in the corpus was closely related to the development of metachronous gastric cancer after ESD.
背景
内镜黏膜下剥离术（ESD）是一种治疗早期胃癌的微创方法。然而，成功治疗癌症后发生异时性癌症的风险仍然很高，且其异时性癌症的危险因素尚未阐明。
目的
通过长期随访，评估 ESD 后发生异时性胃癌的危险因素。
方法
共对 155 例连续患者（男 119 例，女 36 例，平均年龄 68.9 岁）进行 ESD 治疗，这些患者于 2000 年 9 月至 2009 年 9 月间接受治疗。ESD 前，从胃窦大弯和胃体中部取活检标本，评估胃黏膜状态，包括幽门螺杆菌（H.pylori）、肠上皮化生（IM）和中性粒细胞浸润（NI）。ESD 后每 2 个月、6 个月、1 年及之后每年进行内镜随访。如有可能，建议根除 H.pylori。
结果
中位随访时间为 4.2 年。在 155 例患者中，有 23 例（3.5%/年）发现异时性胃癌。未观察到局部复发。在胃体部存在 IM 和 NI 的患者中，异时性胃癌的累积发生率显著升高（P=0.0093 和 P=0.0025，log-rank 检验）。根据 Cox 比例风险模型，胃体部存在 IM 和 NI 的患者的 OR 分别为 2.65 和 3.06（P=0.024 和 P=0.0091）。
结论
胃体部存在 IM 和 NI 与 ESD 后异时性胃癌的发生密切相关。
Zotero 插件