Iguchi Mikitaka, Kato Jun, Yoshida Takeichi, Yamamoto Yasuhide, Nakachi Kenichiro, Fukatsu Kazuhiro, Mori Yoshiyuki, Maeda Yoshimasa, Moribata Kosaku, Shingaki Naoki, Niwa Toru, Deguchi Hisanobu, Inoue Izumi, Maekita Takao, Tamai Hideyuki, Ichinose Masao
Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan.
Int J Cancer. 2016 Sep 1;139(5):1150-6. doi: 10.1002/ijc.30145. Epub 2016 May 5.
We have previously reported that serum pepsinogen (PG) can quantify the level of gastric mucosal atrophy, and that H. pylori eradication reduces cancer development in subjects with mild atrophy identified by serum PG levels. The aim of this study was to elucidate the predictive ability of serum PG levels for the development of metachronous gastric cancer (MGC) after endoscopic resection (ER) of primary cancer in association with H. pylori eradication. A retrospective chart review was performed, and 330 patients who underwent ER for initial early gastric cancer were enrolled. Presence or absence of H. pylori, serum PG levels, and endoscopic atrophy at ER were evaluated. H. pylori eradication was performed at the patient's request after ER. The incidence of MGC in these patients was analyzed. Of 330 patients, 47 developed MGC. Endoscopic extensive atrophy was observed more frequently in patients with MGC (p = 0.001). Although PG I or PG II alone did not significantly differ according to development of MGC, the proportion of PG I/II ≤ 3.0, which is one of the criteria of PG test-positive, was significantly higher in patients with MGC (83 vs. 69%, p = 0.04). H. pylori eradication after ER did not affect MGC development (p = 0.2). On multivariate analysis, serum PG I/II ratio ≤ 3.3 was significantly associated with the development of MGC (hazard ratio: 3.66, 95% confidence interval: 1.47-12.25, p = 0.004). The risk of MGC after ER could be quantitatively predicted by the PG I/II ratio regardless of H. pylori status.
我们之前曾报道，血清胃蛋白酶原（PG）可量化胃黏膜萎缩程度，并且根除幽门螺杆菌可降低血清PG水平所确定的轻度萎缩患者的癌症发生风险。本研究的目的是阐明血清PG水平对原发性癌内镜切除（ER）后异时性胃癌（MGC）发生的预测能力，并与幽门螺杆菌根除情况相关联。我们进行了一项回顾性病历审查，纳入了330例行ER治疗早期胃癌的患者。评估了ER时幽门螺杆菌的有无、血清PG水平及内镜下萎缩情况。ER后根据患者要求进行幽门螺杆菌根除。分析了这些患者中MGC的发生率。330例患者中，47例发生了MGC。MGC患者更常观察到内镜下广泛萎缩（p = 0.001）。尽管单独的PG I或PG II根据MGC的发生情况无显著差异，但PG I/II≤3.0（PG检测阳性标准之一）的比例在MGC患者中显著更高（83%对69%，p = 0.04）。ER后根除幽门螺杆菌不影响MGC的发生（p = 0.2）。多因素分析显示，血清PG I/II比值≤3.3与MGC的发生显著相关（风险比：3.66，95%置信区间：1.47 - 12.25，p = 0.004）。无论幽门螺杆菌状态如何，ER后MGC的风险均可通过PG I/II比值进行定量预测。
