Pittayanon R, Rerknimitr R, Klaikaew N, Sanpavat A, Chaithongrat S, Mahachai V, Kullavanijaya P, Barkun A
Division of Gastroenterology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Division of Gastroenterology, McGill University and the McGill University Health Centre, Montreal, QC, Canada.
Aliment Pharmacol Ther. 2017 Jul;46(1):40-45. doi: 10.1111/apt.14082. Epub 2017 Apr 27.
Gastric intestinal metaplasia (GIM) is the premalignant stage of gastric cancer; however, consensus on its management has not been established.
To determine the risk factors for gastric cancer in a population of patients with GIM to guide the appropriate clinical recommendations in a low prevalence area for gastric cancer.
This was a retrospective cohort study. Ninety-one patients with GIM diagnosed between 2004 and 2014 were recruited for surveillance EGD every 6-12 months until a diagnosis of gastric cancer or completion of the planned 5-year follow-up duration. Possible risk factors for gastric cancer were assessed.
At initial presentation, 81 of the 91 patients (89%) had complete GIM, whereas the remaining 11% had a study entry diagnosis of incomplete GIM. No cancer developed amongst patients with complete GIM. In contrast, five of the 10 patients exhibiting incomplete GIM (50%) progressed to high-grade dysplasia (n=2) or cancer (n=3). Male gender (P=.027), and incomplete GIM (P=.001) were associated with high-risk histology (dysplasia or cancer) by study end. A trend suggested a possible association with smoking (P=.08).
Male patients and those with incomplete GIM are at greatest risk of developing dysplasia or early gastric cancer. Further studies in determining optimal surveillance intervals and impact on cancer incidence and mortality are still required.
胃肠化生（GIM）是胃癌的癌前阶段；然而，关于其管理的共识尚未达成。
确定GIM患者群体中胃癌的危险因素，以指导在胃癌低发地区进行适当的临床建议。
这是一项回顾性队列研究。招募了91例在2004年至2014年间诊断为GIM的患者，每6 - 12个月接受一次内镜检查（EGD）监测，直至诊断为胃癌或完成计划的5年随访期。评估了胃癌可能的危险因素。
初次就诊时，91例患者中有81例（89%）为完全性GIM，其余11%在研究入组时诊断为不完全性GIM。完全性GIM患者中未发生癌症。相比之下，10例不完全性GIM患者中有5例（50%）进展为高级别异型增生（2例）或癌症（3例）。到研究结束时，男性（P = 0.027）和不完全性GIM（P = 0.001）与高危组织学（异型增生或癌症）相关。有一种趋势表明与吸烟可能有关（P = 0.08）。
男性患者和不完全性GIM患者发生异型增生或早期胃癌的风险最高。仍需要进一步研究来确定最佳监测间隔以及对癌症发病率和死亡率的影响。
