Farinati F, Cardin F, Di Mario F, Vianello F, Battaglia G, Arslan-Pagnini C, Cannizzaro R, Sava G A, Rugge M, Naccarato R
Institute of Internal Medicine, University of Padua, Italy.
J Surg Oncol. 1987 Dec;36(4):263-7. doi: 10.1002/jso.2930360410.
One hundred and forty-four patients with apparently benign gastric ulcer were endoscopically followed up in order to evaluate the outcome of the lesion. Particular attention was given to: (a) detect possible delay in diagnosing gastric cancer; (b) ascertain the frequency of association with epithelial dysplasia; (c) establish the role of markers, such as serum pepsinogen group I (PGI), and gastric juice CEA in predicting gastric ulcer evolution. Endoscopic and bioptic check-ups were carried out during the first year at 3, 6 and 12 months after endoscopic healing of the ulcer, and then at every symptomatic recurrence. Ten patients (6.9%) were found to present histological evidence of malignancy (within 3 months in six cases, between 6 and 12 months in three cases, and after 41 months in the rest). Four cases were early gastric cancers, and six had shown dysplastic changes of the mucosa at the edge or scar of the ulcer. Serum PGI levels were not significantly different in gastric cancer patients, while gastric juice CEA levels were sharply increased compared to those of gastric ulcer patients: nine out of ten patients had values above normal range. These data suggest that: (a) there may be some delay in diagnosing gastric carcinoma, and gastric ulcer patients should be controlled routinely more than once; (b) the presence of dysplasia indicates the need for prolonged follow-up, because of the high risk of association with or evolution into gastric cancer, and because of the higher number of early gastric cancer detections that this protocol allows; (c) further support in monitoring patients "at risk" may be afforded by gastric juice CEA determination.
对144例表面良性胃溃疡患者进行了内镜随访，以评估病变的转归。特别关注以下方面：(a) 检测胃癌诊断可能存在的延迟；(b) 确定与上皮发育异常相关的频率；(c) 确定血清胃蛋白酶原I组（PGI）和胃液癌胚抗原等标志物在预测胃溃疡转归中的作用。在溃疡内镜愈合后的第1年，于3、6和12个月进行内镜和活检检查，然后在每次症状复发时进行检查。发现10例患者（6.9%）有恶性组织学证据（6例在3个月内，3例在6至12个月之间，其余在41个月后）。4例为早期胃癌，6例在溃疡边缘或瘢痕处出现黏膜发育异常改变。胃癌患者的血清PGI水平无显著差异，而胃液癌胚抗原水平与胃溃疡患者相比急剧升高：10例患者中有9例值高于正常范围。这些数据表明：(a) 胃癌诊断可能存在延迟，胃溃疡患者应常规进行多次检查；(b) 发育异常的存在表明需要延长随访时间，因为其与胃癌相关或发展为胃癌的风险较高，且该方案允许检测出更多的早期胃癌；(c) 测定胃液癌胚抗原可为监测“高危”患者提供进一步支持。
