Shibukawa Narihiro, Ouchi Shohei, Wakamatsu Shuji, Wakahara Yuhei, Kaneko Akira
Department of Gastroenterology, NTT West Osaka Hospital, Japan.
Intern Med. 2019 Mar 15;58(6):779-784. doi: 10.2169/internalmedicine.0925-18. Epub 2018 Nov 19.
Objective The detection of early gastric cancer (GC) after Helicobacter pylori eradication is expected to increase in Japan. However, the predictive markers for early GC detected after H. pylori eradication have not been extensively studied. We conducted a retrospective, single-center observational study to investigate the predictive markers for early GC detected after H. pylori eradiation. Methods A total of 421 patients underwent endoscopic submucosal dissection for early GC at NTT West Osaka Hospital between June 2006 and August 2017. Data from patients with GC (Group C; n=70) and without GC (Group NC; n=114) after H. pylori eradication were analyzed. Results The proportion of men was significantly higher in Group C than in Group NC (92.9% vs. 65.8%; p<0.0001). Complications with other malignant diseases were more prevalent in Group C than in Group NC. A significantly greater proportion of patients had gastric xanthoma (GX) in Group C than in Group NC (64.3% vs. 14.9%; p<0.0001). Regarding scores for endoscopic findings related to the risk of GC, the atrophy score, intestinal metaplasia score and total score were significantly higher in Group C than in Group NC. A multivariate logistic regression analysis identified male sex, atrophy (open type), the presence of intestinal metaplasia and GX as independent predictors for early GC detected after H. pylori eradication. An atrophy-matched control analysis also identified GX as an independent predictor. Conclusion GX is a novel predictive marker for early GC detected after H. pylori eradication.
目的 在日本，根除幽门螺杆菌后早期胃癌（GC）的检出率有望提高。然而，对于根除幽门螺杆菌后检测到的早期GC的预测标志物尚未进行广泛研究。我们进行了一项回顾性、单中心观察性研究，以调查根除幽门螺杆菌后检测到的早期GC的预测标志物。方法 2006年6月至2017年8月期间，共有421例患者在NTT西大阪医院接受了早期GC的内镜黏膜下剥离术。分析了根除幽门螺杆菌后患有GC的患者（C组；n = 70）和未患有GC的患者（非C组；n = 114）的数据。结果 C组男性比例显著高于非C组（92.9%对65.8%；p < 0.0001）。C组其他恶性疾病并发症的发生率高于非C组。C组胃黄色瘤（GX）患者的比例显著高于非C组（64.3%对14.9%；p < 0.0001）。关于与GC风险相关的内镜检查结果评分，C组的萎缩评分、肠化生评分和总分显著高于非C组。多因素逻辑回归分析确定男性、萎缩（开放型）、肠化生的存在和GX是根除幽门螺杆菌后检测到的早期GC的独立预测因素。萎缩匹配对照分析也确定GX是独立预测因素。结论 GX是根除幽门螺杆菌后检测到的早期GC的一种新型预测标志物。
