2007年至2016年挪威中部地区上消化道内镜检查漏诊的胃癌——一项基于人群的研究
Gastric Cancers Missed at Upper Endoscopy in Central Norway 2007 to 2016-A Population-Based Study.
作者信息
Beck Marianne, Bringeland Erling A, Qvigstad Gunnar, Fossmark Reidar
机构信息
Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway.
Department of Gastrointestinal Surgery, St Olav's Hospital, Trondheim University Hospital, Prinsesse Kristinas Gate 1, 7030 Trondheim, Norway.
出版信息
Cancers (Basel). 2021 Nov 10;13(22):5628. doi: 10.3390/cancers13225628.
BACKGROUND
The rates of missed gastric cancers (MGC) at upper endoscopy (UE) has been reported at 5-10% in Western countries. We aimed to calculate the rate of MGC and identify factors associated with MGC.
METHODS
Retrospective population-based cohort study including 730 patients diagnosed with gastric adenocarcinoma in Central Norway 2007-2016. MGCs were incident gastric adenocarcinomas diagnosed 6-36 months after a previous UE. Factors associated with MGC were examined. Definitely missed (UE 6-12 months prior) and potentially missed (UE 12-36 months prior) MGCs were compared.
RESULTS
Sixty-seven (9.2%) of 730 gastric cancers were MGC. MGC were associated with localization ( = 0.009) and more frequent in the corpus, Lauren's histological type ( = 0.028) and diffuse type more prevalent, and previous Billroth 2-operation (14.9% vs. 4.7%, = 0.001). MGCs were diagnosed at earlier stages ( = 0.037). An ulceration was more common in patients with definitely missed than potentially MGC (40.9% vs. 17.8%, = 0.041).
CONCLUSIONS
MGC accounted for 9.2% of gastric cancers in Central Norway. MGC were associated with localization in the corpus, Lauren´s diffuse type and previous Billroth-2-operation. Intensified follow-up and adequate biopsy sampling of patients with gastric ulcerations could reduce the rate of missed gastric cancers.
背景
西方国家报道上消化道内镜检查（UE）时胃癌漏诊率为5%-10%。我们旨在计算胃癌漏诊率并确定与胃癌漏诊相关的因素。
方法
基于人群的回顾性队列研究，纳入2007年至2016年在挪威中部诊断为胃腺癌的730例患者。胃癌漏诊是指在前次UE检查后6至36个月确诊的新发胃腺癌。研究了与胃癌漏诊相关的因素。比较了明确漏诊（前次UE检查6至12个月前）和可能漏诊（前次UE检查12至36个月前）的胃癌。
结果
730例胃癌中有67例（9.2%）为漏诊病例。胃癌漏诊与病变部位有关（P = 0.009），胃体部更为常见，Lauren组织学类型有关（P = 0.028），弥漫型更为普遍，以及既往毕Ⅱ式手术（14.9%对4.7%，P = 0.001）。漏诊的胃癌诊断时分期较早（P = 0.037）。明确漏诊的患者比可能漏诊的患者溃疡更为常见（40.9%对17.8%，P = 0.041）。
结论
在挪威中部，胃癌漏诊占胃癌的9.2%。胃癌漏诊与胃体部病变、Lauren弥漫型以及既往毕Ⅱ式手术有关。加强对胃溃疡患者的随访和充分的活检取样可降低胃癌漏诊率。
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