OLGA 胃炎分级对胃癌风险预测的研究：一项对 7436 例患者的长期随访研究。
OLGA Gastritis Staging for the Prediction of Gastric Cancer Risk: A Long-term Follow-up Study of 7436 Patients.
机构信息
Department of Medicine (DIMED), Surgical pathology & Cytopathology Unit, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy. Veneto Tumor Registry, Veneto Region, Padova, Italy. Departments of Pathology and Medicine, Baylor College of Medicine, Houston, TX, USA. Inform Diagnostics Research Institute, Irving, TX, USA. Department of Oncology and Gastroenterology (DISGOG), Gastroenterology Unit, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy. Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany.
出版信息
Am J Gastroenterol. 2018 Nov;113(11):1621-1628. doi: 10.1038/s41395-018-0353-8. Epub 2018 Oct 17.
OBJECTIVES
Gastritis OLGA-staging ranks the risk for gastric cancer (GC) in progressive stages (0-IV). This long-term follow-up study quantifies the GC risk associated with each OLGA stage.
METHODS
Consecutive patients (7436) underwent esophagogastroscopy (T-0), with mapped gastric biopsies, OLGA staging, and H. pylori status assessment. Patients with neoplastic lesion (invasive or non-invasive) at the index endoscopy (and/or within 12 months) were excluded. All patients were followed-up (T-1) by combining different sources of clinical/pathological information (Regional Registries of: (i) esophagogastroduodenoscopies; (ii) pathology reports; (iii) cancer, (iv) mortality). The endpoint was histologically documented development of gastric epithelial neoplasia.
RESULTS
At T-0, the patients' distribution by OLGA stage was: Stage 0 = 80.8%; Stage I = 12.6%; Stage II = 4.3%; Stage III = 2.0%; Stage IV = 0.3%; H. pylori infection was detected in 25.9% of patients. At the end of the follow-up (mean/median = 6.3/6.6 years), 28 incident neoplasia were documented (overall prevalence = 0.60 per 10/person-years; low-grade intraepithelial neoplasia = 17/28; high-grade intraepithelial neoplasia = 4/28; GC = 7/28). By OLGA stage at the enrollment, the rate of incident neoplasia was: Stage 0 = 1 case; rate/10 person-years = 0.03; 95%CI: 0.004-0.19; Stage I = 2 cases; rate/10 person-years = 0.34; 95%CI: 0.09-1.36; Stage II = 3 cases; rate/10 person-years = 1.48; 95%CI: 0.48-4.58; Stage III = 17 cases; rate/10 person-years = 19.1; 95%CI: 11.9-30.7; Stage IV = 5 cases; rate/10 person-years = 41.2; 95%CI: 17.2-99.3. Multivariate analysis including gender, age, H. pylori status, and OLGA stage at enrollment only disclosed OLGA stage as predictor of neoplastic progression (OLGA stage III: HR = 712.4, 95%CI = 92.543-5484.5; OLGA stage IV: HR = 1450.7, 95%CI = 166.7-12626.0).
CONCLUSIONS
Among 7436 patients, OLGA stages at the enrollment correlated significantly with different risk for gastric neoplasia. Based on the obtained results, gastritis staging is a critical adjunct in endoscopy follow-up protocols aimed at GC secondary prevention.
目的
胃炎 OLGA 分期将胃癌（GC）的风险分为不同的进展阶段（0-IV）。本长期随访研究定量评估了每个 OLGA 阶段与 GC 风险的关联。
方法
连续纳入（7436 例）患者接受食管胃十二指肠镜检查（T-0），并进行胃活检、OLGA 分期和幽门螺杆菌状态评估。将索引内镜检查中存在肿瘤病变（侵袭性或非侵袭性）的患者（以及/或在 12 个月内）排除在外。所有患者通过结合不同来源的临床/病理信息（（i）食管胃十二指肠镜检查；（ii）病理报告；（iii）癌症；（iv）死亡率）进行 T-1 随访。终点是组织学证实胃上皮肿瘤的发展。
结果
在 T-0 时，患者按 OLGA 分期的分布为：0 期=80.8%；I 期=12.6%；II 期=4.3%；III 期=2.0%；IV 期=0.3%；25.9%的患者检测到幽门螺杆菌感染。在随访结束时（平均/中位数=6.3/6.6 年），记录了 28 例新发肿瘤（总患病率为 0.60/10/人年；低级别上皮内瘤变=17/28；高级别上皮内瘤变=4/28；GC=7/28）。按纳入时的 OLGA 分期，新发肿瘤的发生率为：0 期=1 例；发生率/10 人年=0.03；95%CI：0.004-0.19；I 期=2 例；发生率/10 人年=0.34；95%CI：0.09-1.36；II 期=3 例；发生率/10 人年=1.48；95%CI：0.48-4.58；III 期=17 例；发生率/10 人年=19.1；95%CI：11.9-30.7；IV 期=5 例；发生率/10 人年=41.2；95%CI：17.2-99.3。包括性别、年龄、幽门螺杆菌状态和纳入时的 OLGA 分期在内的多变量分析仅揭示 OLGA 分期是肿瘤进展的预测因素（OLGA 分期 III：HR=712.4，95%CI=92.543-5484.5；OLGA 分期 IV：HR=1450.7，95%CI=166.7-12626.0）。
结论
在 7436 例患者中，纳入时的 OLGA 分期与胃肿瘤不同风险显著相关。基于获得的结果，胃炎分期是旨在预防 GC 的内镜随访方案中的重要辅助手段。
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