Yoshida Naohisa, Maeda-Minami Ayako, Ishikawa Hideki, Mutoh Michihiro, Kanno Yui, Tomita Yuri, Hirose Ryohei, Dohi Osamu, Itoh Yoshito, Mano Yasunari
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
Department of Clinical Drug Informatics, Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba, Japan.
J Gastroenterol. 2023 Nov;58(11):1105-1113. doi: 10.1007/s00535-023-02035-1. Epub 2023 Aug 30.
Colorectal endoscopic resection (C-ER) is spreading due to the increase of colorectal cancer (CRC) in Japan. Gastric cancer (GC) sometimes occurs after C-ER. We aimed to analyze the status of GC after C-ER using large-scale data.
We retrospectively used commercially anonymized health insurance claims data of 5.71 million patients from 2005 to 2018, and extracted 62,392 patients ≥ 50 years old who received C-ER. The incidence and risk factors of GC were analyzed. Additionally, subjects were divided into ≥ 2 cm group and < 2 cm group and risks of GC were analyzed.
The median age (range) was 58 (50-75) years and the overall rate of GC was 0.68% (423/62,392). Multivariate analysis showed that significant risk factors for GC [odds rates (OR), 95% confidence interval (CI)] were colorectal lesion size ≥ 2 cm (1.75, 1.24-2.47, p = 0.002), age ≥ 65 y.o. (1.65, 1.31-2.07, p < 0.001), male (2.35, 1. 76-3.13, p < 0.001), diabetes mellitus (1.40, 1.02-1.92, p = 0.035), liver disease (1.54, 1.06-2.24, p = 0.025), Helicobacter pylori infection (2.10, 1.65-2.67, p < 0.001), chronic atrophic gastritis (1.58, 1.14-2.18, p = 0.006), and CRC (1.72, 1.10-2.68, p = 0.017). The rate of GC in the ≥ 2 cm was significantly higher than that in < 2 cm groups (1.17% and 0.65%, p < 0.001). According to the number of significant risk factors, the rates of GC and the hazard ratios of GC (95%CI) were 0.64% and 3.64 (2.20-6.02) and 1.95% and 11.17 (6.57-19.00) for patient with 1-2 and ≥ 3 risk factors, compared with patients without risk factors.
Using large-scale data, risk factors for GC, including colorecal lesions ≥ 2 cm after C-ER could be investigated.
由于日本结直肠癌（CRC）发病率的增加，结直肠内镜切除术（C-ER）正在普及。胃癌（GC）有时会在C-ER后发生。我们旨在使用大规模数据分析C-ER后GC的情况。
我们回顾性地使用了2005年至2018年571万患者的商业匿名医疗保险理赔数据，提取了62392例年龄≥50岁接受C-ER的患者。分析了GC的发病率和危险因素。此外，将受试者分为≥2 cm组和<2 cm组，并分析GC的风险。
中位年龄（范围）为58（50 - 75）岁，GC的总体发生率为0.68%（423/62392）。多因素分析显示，GC的显著危险因素[比值比（OR），95%置信区间（CI）]为结直肠病变大小≥2 cm（1.75，1.24 - 2.47，p = 0.002）、年龄≥65岁（1.65，1.31 - 2.07）、男性（2.35，1.76 - 3.13）、糖尿病（1.40，1. Q2 - 1.92）、肝病（1.54，1.06 - 2.24）、幽门螺杆菌感染（2.10，1.65 - 2.67）、慢性萎缩性胃炎（1.58，1.1 Q - 2.18）和CRC（1.72，1.10 - 2.68）。≥2 cm组的GC发生率显著高于<2 cm组（1.17%和0.65%，p < 0.001）。根据显著危险因素的数量，与无危险因素的患者相比，有1 - 2个和≥3个危险因素的患者GC发生率和GC风险比（95%CI）分别为0.64%和3.64（2.20 - 6.02）以及1.95%和11.17（6.57 - 19.00）。
使用大规模数据，可以研究C-ER后GC的危险因素，包括结直肠病变≥2 cm。
