家族性腺瘤性息肉病中与胃癌相关的内镜和组织学特征。

Endoscopic and histologic features associated with gastric cancer in familial adenomatous polyposis.

机构信息

Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.

Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.

出版信息

Gastrointest Endosc. 2019 May;89(5):961-968. doi: 10.1016/j.gie.2018.12.018. Epub 2018 Dec 28.

DOI:10.1016/j.gie.2018.12.018

PMID:30597145

Abstract

BACKGROUND AND AIMS

Gastric cancer (GC) is a newly described cancer risk in Western patients with familial adenomatous polyposis (FAP). Little is known about clinical, endoscopic, and pathologic features associated with FAP-related GC. We compared these features in FAP patients with and without GC.

METHODS

FAP patients were identified through the David G. Jagelman Inherited Colorectal Cancer Registries Cologene database. FAP patients with GC and randomly selected FAP patients without GC who had undergone at least 2 EGDs were analyzed. Demographic, clinical, endoscopic, and pathologic features were compared.

RESULTS

Ten FAP patients with GC were identified, and 40 age-matched FAP control subjects were selected. No demographic differences were noted between patients and control subjects. All GC cases arose in the proximal stomach among gastric polyposis, with only 2 endoscopically visible. The prevalence of gastric polyposis was similar (100% vs 93%). Endoscopic features associated with GC included a carpeting of gastric polyps (100% vs 22.5%), solitary polyps >20 mm (100% vs 0%), and a polypoid mound of polyps (80% vs 0%; all P < .001). GC patients had a higher prevalence of gastric adenomas (30% vs 5%, P = .048) and polyps with high-grade dysplasia, including fundic gland polyps (50% vs 10%, P = .01) and pyloric gland adenomas (20% vs 0%, P = .037).

CONCLUSIONS

We identified endoscopic features and advanced pathology present in the stomachs of Western patients with FAP who developed GC. Upper GI surveillance in FAP should include the stomach and awareness of features associated with GC. Optimal approaches to treatment of gastric polyposis and methods of identification of early GC precursors in FAP are needed.

摘要

背景与目的

胃癌（GC）是一种在西方家族性腺瘤性息肉病（FAP）患者中新发现的癌症风险。关于与 FAP 相关的 GC 的临床、内镜和病理特征知之甚少。我们比较了 FAP 患者中有无 GC 的这些特征。

方法

通过 David G. Jagelman 遗传性结直肠癌登记处 Cologene 数据库确定 FAP 患者。分析了患有 GC 的 FAP 患者和随机选择的至少接受过 2 次内镜检查的无 GC 的 FAP 患者。比较了人口统计学、临床、内镜和病理特征。

结果

确定了 10 例 FAP 合并 GC 的患者，并选择了 40 例年龄匹配的 FAP 对照患者。患者与对照之间没有发现人口统计学差异。所有 GC 病例均发生在胃息肉的近端胃中，仅 2 例可通过内镜观察到。胃息肉的患病率相似（100%对 93%）。与 GC 相关的内镜特征包括胃息肉的地毯状（100%对 22.5%）、>20mm 的单发息肉（100%对 0%）和息肉样隆起的息肉（80%对 0%；均 P<0.001）。GC 患者胃腺瘤的患病率更高（30%对 5%，P=0.048），并且存在高级别异型增生的息肉，包括胃底腺息肉（50%对 10%，P=0.01）和幽门腺腺瘤（20%对 0%，P=0.037）。