临床和内镜预测胃前癌状况：一项大型人群病例对照研究。

Clinical and endoscopic predictors of gastric precancerous conditions: a large population case control study.

机构信息

Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center Affiliated to the Technion Faculty of Medicine of Haifa, Hadera, Israel.

Department of Gastroenterology, Nazareth EMMS Hospital Affiliated with the Faculty of Medicine, Bar Illan University, Bar Illan, Israel -

出版信息

Minerva Gastroenterol (Torino). 2022 Dec;68(4):400-406. doi: 10.23736/S2724-5985.21.03007-2.

DOI:10.23736/S2724-5985.21.03007-2

PMID:36507828

Abstract

BACKGROUND

Atrophic gastritis (AG) and gastric intestinal metaplasia (GIM) are well defined intermediate precancerous conditions (PCCs) in the gastric cancer cascade. The diagnosis of PCCs may be suspected based on endoscopic findings but is established by histology. Estimates of the global prevalence of PCCs vary widely but simple clinical or endoscopic predictors of their diagnosis are ill defined. We aimed to evaluate the prevalence of gastric PCCs in our practice and to identify predictors for its diagnosis.

METHODS

We analyzed electronic reports of patients referred for gastroscopy procedures over a 5-year period and included those for whom gastric biopsies were performed. We investigated demographic, clinical, and endoscopic findings to identify possible association with histologic detection of gastric PCCs and performed multivariate analysis to identify predictors of its diagnosis.

RESULTS

A total of 4930 patients with full endoscopic and histologic data were included for the final analysis. Of these, 806 (16.3%) patients had a histologic diagnosis of gastric PCCs. Demographic and clinical variables including male sex (51.4% vs. 45.7%; P=0.003), age over 60 (69.8% vs. 45.2%; P<0.001), and anemia indication for gastroscopy (17.6% vs. 14.8%; P=0.04) were significantly associated with gastric PCCs diagnosis. Likewise, endoscopic findings of Barret's esophagus (2.6% vs. 1.3%; P=0.006), atrophic gastritis according to endoscopist's judgment (12.9% vs. 3.5%; P<0.01) and corpus predominant gastritis (22.5% vs. 14.7%; P=0.02) were significantly associated with gastric PCCs. In multivariate analysis, age>60 (please explain all acronyms HR 2.51, 95% CI 2.12-2.96), male sex (HR 1.235, 95% CI 1.05-1.44), corpus predominant (HR 1.284, 95% CI 1.04-1.57), and atrophic gastritis (HR 4, 95% CI 3.07-5.21) were independent predictors for PCCs diagnosis.

CONCLUSIONS

Not uncommonly encountered in our practice, a judicious performance of gastric biopsies to detect gastric PCCs should be adopted especially in older, male patients with endoscopic findings of corpus predominant and/or gastric atrophy.

摘要

背景

萎缩性胃炎（AG）和肠上皮化生（GIM）是胃癌发生过程中明确的中间癌前状态（PCC）。PCC 的诊断可能基于内镜发现，但需要通过组织学来确定。PCC 全球患病率的估计差异很大，但简单的临床或内镜预测因素尚未明确。我们旨在评估我们实践中胃 PCC 的患病率，并确定其诊断的预测因素。

方法

我们分析了 5 年内接受胃镜检查的患者的电子报告，并纳入了进行胃活检的患者。我们研究了人口统计学、临床和内镜发现，以确定与胃 PCC 组织学检测可能相关的因素，并进行了多变量分析以确定其诊断的预测因素。

结果

共有 4930 名患者具有完整的内镜和组织学数据，最终纳入了分析。其中，806 名（16.3%）患者的组织学诊断为胃 PCC。人口统计学和临床变量，包括男性（51.4%比 45.7%；P=0.003）、年龄>60 岁（69.8%比 45.2%；P<0.001）和胃镜检查的贫血指征（17.6%比 14.8%；P=0.04）与胃 PCC 诊断显著相关。同样，内镜下发现巴雷特食管（2.6%比 1.3%；P=0.006）、内镜医师判断的萎缩性胃炎（12.9%比 3.5%；P<0.01）和胃体为主的胃炎（22.5%比 14.7%；P=0.02）与胃 PCC 显著相关。多变量分析显示，年龄>60 岁（请解释所有缩写 HR 2.51，95%CI 2.12-2.96）、男性（HR 1.235，95%CI 1.05-1.44）、胃体为主（HR 1.284，95%CI 1.04-1.57）和萎缩性胃炎（HR 4，95%CI 3.07-5.21）是 PCC 诊断的独立预测因素。