CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Nantes, France.
Université de Nantes, Nantes, France.
Clin Transl Gastroenterol. 2020 Dec;11(12):e00237. doi: 10.14309/ctg.0000000000000237.
Data on the evolution of gastric precancerous lesions (GPL), especially in countries of a Low gastric cancer incidence area are limited. Our objective was to study a long-term evolution of GPL in France.
All the patients diagnosed with GPL (atrophic gastritis, intestinal metaplasia [IM], and dysplasia) between 2000 and 2015 and fulfilling criteria for evolution assessment (at least 2 endoscopies, minimal follow-up of 6 months, and at least 2 biopsies obtained from the antrum and corpus) were included. Clinical and endoscopic data were analyzed, and histological samples were reviewed by an expert pathologist with evaluation of the Operative Link on Gastric Intestinal Metaplasia Assessment stage and type of IM.
From the 507 patients with GPL, 79 fulfilled the strict criteria. During a mean follow-up of 66 months, during which the patients had a mean number of 4 endoscopies (min-max: 2-21) with 9 biopsies/endoscopy, a stability was observed in 70% of patients. Progression occurred in 14% of patients, within a mean delay of 62.1 months (min-max: 17-99). Progression of the lesions was significantly higher in patients with incomplete type of IM (relative risk of progression for incomplete IM: 11.5; 95% confidence interval 2.5-53.1). Regression of IM occurred in 16% of the patients, after a mean delay of 90 months.
This study shows that the patients with antrum-limited IM, especially of incomplete type, are at the highest risk of developing gastric cancer. In most patients, however, the lesions remain stable, which highlights the need for additional markers to better target the patients at risk of progression.
关于胃癌前病变（GPL）的演变的数据，特别是在低胃癌发病率国家的数据有限。我们的目的是研究法国 GPL 的长期演变。
所有在 2000 年至 2015 年间诊断为 GPL（萎缩性胃炎、肠上皮化生[IM]和发育不良）并符合进化评估标准的患者（至少进行 2 次内镜检查，至少 6 个月的随访，至少 2 次从胃窦和胃体获得的活检）均纳入研究。分析了临床和内镜数据，并由一位专家病理学家对组织学样本进行了评估，评估了胃肠上皮化生评估操作链接的阶段和 IM 的类型。
从 507 例 GPL 患者中，有 79 例符合严格标准。在平均 66 个月的随访期间，患者平均进行了 4 次内镜检查（最小最大：2-21 次），每次内镜检查有 9 次活检，70%的患者病情稳定。14%的患者发生进展，平均延迟 62.1 个月（最小最大：17-99 个月）。IM 不完全型患者病变进展显著较高（不完全 IM 的进展相对风险：11.5；95%置信区间 2.5-53.1）。IM 消退发生在 16%的患者中，平均延迟 90 个月。
本研究表明，胃窦局限性 IM 患者，尤其是不完全型患者，发生胃癌的风险最高。然而，在大多数患者中，病变仍然稳定，这突出表明需要额外的标志物来更好地针对进展风险患者。
