Wen Denggui, Zhang Liwei, Wang Xiaoling, Li Yongwei, Ma Caifeng, Liu Xu, Zhang Junli, Wen Xiaoduo, Yang Yi, Zhang Fuzhi, Wang Shijie, Shan Baoen
Cancer Institute, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Endoscope, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
J Gastroenterol Hepatol. 2015 Dec;30(12):1720-5. doi: 10.1111/jgh.13040.
This study aimed to estimate the time to precursor progression and to identify significant predicators.
One hundred thirty-three precursor and 311 normal cases detected in a population-based screening were surveyed for 5.5 years. Precursor progression was defined as worsening of dysplasia or development of a new precursor. Time to precursor progression was estimated by the Kaplan-Meier method. Significant predicators were estimated by Cox proportional regression.
Of the 133 precursor cases, 33.08% (44/133) progressed or recurred, 30.08% (40/133) persisted, and 36.84% (49/133) regressed; of the 311 normal subjects, 13.50% (42/311) developed a precursor. Progression occurred significantly earlier and more frequently with ncreasing histology: with mind dysplasia (mD), 7.8% progressed by 1 year and 23.3% progressed by 5 year; with moderate dysplasia (MD), 18% progressed by 1 year and 70% progressed by 5 years; and with severe dysplasia, 50% progressed by 1 year and 100% progressed by 5 years. The difference between any two groups was significant. In addition, the marginal Lugol-stained mucosa at endoscopic mucosal resection had a progressing risk similar to that of MD, and basal cell hyperplasia was similar to that of mD. Significant predicators for precursor progression included male sex (hazard ratio and 95% CI: 2.74 (1.63-4.60)), age over 50 years (2.31 (1.33-4.02)), family history of upper gastrointestinal cancer (UGIC) (1.56 (1.00-2.45)), multifocal dysplasia (5.11 (3.01-8.68)), and baseline histology.
Sex, age, family history of UGIC, multifocal dysplasia, and baseline histology are significant independent predicators for precursor progression. Patients after endoscopic mucosal resection should be continuously surveyed.
本研究旨在评估前驱病变进展的时间并确定重要的预测因素。
对在基于人群的筛查中检测出的133例前驱病变患者和311例正常患者进行了5.5年的随访。前驱病变进展定义为发育异常加重或出现新的前驱病变。采用Kaplan-Meier法评估前驱病变进展的时间。通过Cox比例回归分析确定重要的预测因素。
在133例前驱病变患者中，33.08%（44/133）发生进展或复发，30.08%（40/133）持续存在，36.84%（49/133）好转；在311例正常受试者中，13.50%（42/311）出现前驱病变。随着组织学改变的加重，进展出现得更早且更频繁：轻度发育异常（mD）患者中，1年时7.8%发生进展，5年时23.3%发生进展；中度发育异常（MD）患者中，1年时18%发生进展，5年时70%发生进展；重度发育异常患者中，1年时50%发生进展，5年时100%发生进展。任意两组之间的差异均具有统计学意义。此外，内镜下黏膜切除术时边缘碘染色黏膜的进展风险与中度发育异常相似，基底细胞增生与轻度发育异常相似。前驱病变进展的重要预测因素包括男性（风险比及95%可信区间：2.74（1.63 - 4.60））、50岁以上（2.31（1.33 - 4.02））、上消化道癌（UGIC）家族史（1.56（1.00 - 2.45））、多灶性发育异常（5.11（3.01 - 8.68））以及基线组织学。
性别、年龄、UGIC家族史、多灶性发育异常和基线组织学是前驱病变进展的重要独立预测因素。内镜下黏膜切除术后的患者应持续接受随访。
