Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
Clin Gastroenterol Hepatol. 2016 Oct;14(10):1420-5. doi: 10.1016/j.cgh.2016.05.045. Epub 2016 Jun 16.
BACKGROUND & AIMS: Gastric intestinal metaplasia (GIM) is a common finding from routine endoscopies. Although GIM is an early step in gastric carcinogenesis, there is controversy regarding routine surveillance of patients with GIM in regions with a low prevalence of gastric cancer. We aimed to determine the incidence of gastric cancer among patients with GIM and risk factors for gastric cancer.
We performed a retrospective cohort study of patients from the Kaiser Permanente Southern California region diagnosed with GIM from 2000 through 2011. GIM was identified by a keyword search of pathology reports; gastric cancer cases were identified by cross-reference with an internal cancer registry. The incidence of gastric cancer in patients with GIM (n = 923; median age at diagnosis, 68 y) was compared with that of an age- and sex-matched reference population (controls). Risk factors such as ethnicity, smoking status, history of Helicobacter pylori infection, and family history of gastric cancer were evaluated by individual Cox proportional hazards regression. We then performed a second case-cohort study to evaluate the risk of gastric cancer based on the location and extent of GIM. The median duration of follow-up evaluation was 4.6 years (interquartile range, 3.0-6.7 y).
We identified 25 patients with GIM who developed gastric cancers. Seventeen cases of cancer were diagnosed at the same time as the diagnosis of GIM. Eight cases of cancer were identified within a median time period of 4.6 years after a diagnosis of GIM (interquartile range, 2-5.7 y). The overall incidence rate for the cohort was 1.72 (95% confidence interval, 0.74-3.39). Among the risk factors evaluated, only family history (hazard ratio, 3.8; 95% confidence interval, 1.5-9.7; P = .012) and extent of GIM (odds ratio, 9.4; 95% confidence interval, 1.8-50.4) increased the risk for gastric cancer. The incidence rate for gastric cancer in patients with a positive family history was 8.12 (95% confidence interval, 1.67-23.73).
In an analysis of patients with GIM listed in the Kaiser Permanente Southern California database, 2.7% were diagnosed with gastric cancer; almost 70% of cases of gastric cancer were detected at the time of GIM diagnosis. Family history and extensive metaplasia were associated with an increased risk of subsequent gastric cancer. Targeted surveillance of patients with these criteria could increase early detection of gastric cancer.
胃肠上皮化生（GIM）是常规内镜检查的常见发现。尽管 GIM 是胃癌发生的早期步骤，但在胃癌发病率较低的地区，对 GIM 患者进行常规监测存在争议。我们旨在确定 GIM 患者中胃癌的发生率和胃癌的危险因素。
我们对 2000 年至 2011 年期间在凯撒永久南加州地区被诊断为 GIM 的患者进行了回顾性队列研究。通过对病理报告进行关键词搜索来识别 GIM；通过与内部癌症登记处交叉引用来识别胃癌病例。GIM 患者（n=923；诊断时的中位年龄为 68 岁）的胃癌发生率与年龄和性别匹配的参考人群（对照组）进行比较。通过个体 Cox 比例风险回归评估种族、吸烟状况、幽门螺杆菌感染史和胃癌家族史等危险因素。然后，我们进行了第二次病例-队列研究，以根据 GIM 的位置和程度评估胃癌的风险。中位随访评估时间为 4.6 年（四分位间距，3.0-6.7 年）。
我们确定了 25 例患有 GIM 并发展为胃癌的患者。17 例癌症病例与 GIM 的诊断同时诊断。在 GIM 诊断后中位数为 4.6 年（四分位间距，2-5.7 年）期间，诊断出 8 例癌症。该队列的总体发生率为 1.72（95%置信区间，0.74-3.39）。在所评估的危险因素中，只有家族史（风险比，3.8；95%置信区间，1.5-9.7；P=0.012）和 GIM 的程度（比值比，9.4；95%置信区间，1.8-50.4）增加了胃癌的风险。有阳性家族史的患者胃癌发生率为 8.12（95%置信区间，1.67-23.73）。
在对凯撒永久南加州数据库中列出的 GIM 患者进行的分析中，有 2.7%被诊断患有胃癌；近 70%的胃癌病例是在 GIM 诊断时发现的。家族史和广泛的化生与随后发生胃癌的风险增加有关。对具有这些标准的患者进行有针对性的监测可以提高胃癌的早期发现率。
