Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, Alway Building, M211, Stanford, CA, 94305, USA.
Cancer Causes Control. 2022 Feb;33(2):183-191. doi: 10.1007/s10552-021-01522-1. Epub 2021 Nov 19.
Gastric cancers are classified as diffuse-type (DTGC) or intestinal-type (ITGC). DTGCs have distinct clinical and histopathologic features, and carry a worse overall prognosis compared to ITGCs. Atrophic gastritis (AG) and intestinal metaplasia (IM) are known precursors to ITGC. It is unknown if AG and IM increase risk for DTGC.
We performed a systematic review to identify studies reporting on the association of AG/IM and DTGC. We extracted the odds ratio (OR) of the association from studies, and performed pool analysis. Subgroup analysis was performed on studies reporting histologic severity (using operative link systems) to assess if histologic severity of AG/IM was associated with higher risk.
We identified six case-control and eight cohort studies for inclusion. Both AG (pooled OR = 1.9, 95% CI 1.5 to 2.4, p < 0.001) and IM (pooled OR = 2.3, 95% CI 1.9 to 2.9, p < 0.001) demonstrated an association with DTGC. High AG severity was associated with increased risk for DTGC compared to low AG severity (OR = 1.7, 95% CI 1.2 to 2.3, p = 0.002). Similarly, high IM severity was associated with increased risk compared to low IM severity (OR = 1.9, 95% CI 1.3 to 2.7, p = 0.001).
Both AG and IM are associated with DTGC. Increasing histologic severity of both AG and IM increases risk for DTGC. There may exist a common pathway between ITGC and some DTGCs mediated through mucosal precursor lesions. These data may inform future strategies of cancer risk attenuation and control.
胃癌分为弥漫型（DTGC）或肠型（ITGC）。与 ITGC 相比，DTGC 具有明显的临床和组织病理学特征，总体预后较差。萎缩性胃炎（AG）和肠上皮化生（IM）是 ITGC 的已知前体。AG 和 IM 是否会增加 DTGC 的风险尚不清楚。
我们进行了系统评价，以确定报告 AG/IM 与 DTGC 相关性的研究。我们从研究中提取关联的优势比（OR），并进行汇总分析。对报告组织学严重程度（使用操作链接系统）的研究进行亚组分析，以评估 AG/IM 的组织学严重程度是否与更高的风险相关。
我们确定了纳入的 6 项病例对照研究和 8 项队列研究。AG（汇总 OR=1.9，95%CI 1.5 至 2.4，p<0.001）和 IM（汇总 OR=2.3，95%CI 1.9 至 2.9，p<0.001）均与 DTGC 相关。与低 AG 严重程度相比，高 AG 严重程度与 DTGC 风险增加相关（OR=1.7，95%CI 1.2 至 2.3，p=0.002）。同样，与低 IM 严重程度相比，高 IM 严重程度与增加的风险相关（OR=1.9，95%CI 1.3 至 2.7，p=0.001）。
AG 和 IM 均与 DTGC 相关。AG 和 IM 的组织学严重程度增加均会增加 DTGC 的风险。在某些 DTGC 中，可能存在通过黏膜前体病变介导的 ITGC 和某些 DTGC 之间的共同途径。这些数据可能为未来的癌症风险衰减和控制策略提供信息。
