Shibukawa Narihiro, Ouchi Shohei, Wakamatsu Shuji, Wakahara Yuhei, Kaneko Akira
Department of Gastroenterology NTT West Osaka Hospital Osaka Japan.
Department of Internal Medicine Osaka Police Hospital Osaka Japan.
JGH Open. 2020 Dec 14;5(2):249-252. doi: 10.1002/jgh3.12479. eCollection 2021 Feb.
Successful eradication has been shown to prevent the development of gastric cancer (GC), but clinical evidence for factors that correlate with GC of previously -infected gastric mucosa (after eradication or natural disappearance) is limited. The purpose of our study was to identify these correlative factors.
We retrospectively examined data from patients with previously -infected gastric mucosa. Data from 168 patients who developed early GC and underwent endoscopic submucosal dissection (Group C) and 835 patients with no history of early GC (Group NC) were compared. We extracted data on gender; age; complications from malignant disease and diabetes mellitus; American Society of Anesthesiologists (ASA) physical status classification; and endoscopic characteristics of atrophy (open type), intestinal metaplasia, and gastric xanthoma (GX). Correlations were determined with multivariate logistic regression analysis and propensity score matching.
A significantly higher proportion of patients had GX in Group C than in Group NC. Age, male gender, ASA physical status classification of class III or higher, complications from malignant disease, atrophy (open type), and the presence of intestinal metaplasia and GX were identified as factors that correlated independently with GC (odds ratio = 3.65; 95% confidence interval = 2.37-5.61; < 0.0001). Propensity score matching demonstrated that the prevalence of GC was also significantly higher in patients who were positive for GX (37.2% 18.3%; < 0.0001).
GX was shown to correlate with early GC of previously -infected gastric mucosa.
已证实成功根除幽门螺杆菌可预防胃癌(GC)的发生,但关于先前感染过胃黏膜(根除后或自然消失)的患者中与胃癌相关因素的临床证据有限。本研究的目的是确定这些相关因素。
我们回顾性分析了先前感染过胃黏膜患者的数据。比较了168例发生早期胃癌并接受内镜下黏膜下剥离术的患者(C组)和835例无早期胃癌病史的患者(非C组)的数据。我们提取了有关性别、年龄、恶性疾病和糖尿病并发症、美国麻醉医师协会(ASA)身体状况分类以及萎缩(开放型)、肠化生和胃黄色瘤(GX)的内镜特征的数据。通过多因素逻辑回归分析和倾向评分匹配来确定相关性。
C组患者中GX的比例显著高于非C组。年龄、男性、ASA身体状况分类为III级或更高、恶性疾病并发症、萎缩(开放型)以及肠化生和GX的存在被确定为与胃癌独立相关的因素(比值比=3.65;95%置信区间=2.37-5.61;P<0.0001)。倾向评分匹配显示,GX阳性患者中胃癌的患病率也显著更高(37.2%对18.3%;P<0.0001)。
结果表明,GX与先前感染过胃黏膜的患者发生早期胃癌相关。