Wei Yali, Min Congcong, Zhao Chongguang, Li Yubei, Wang Xiaowei, Jing Xue, Yu Yanan, Li Xiaoyu, Yin Xiaoyan
Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Department of Clinical Medicine, Qingdao University Medical College, Qingdao, Shandong, China.
Front Oncol. 2023 Oct 2;13:1272187. doi: 10.3389/fonc.2023.1272187. eCollection 2023.
Gastric cancer still develops after successful Helicobacter pylori(Hp)eradication. In this study, we aimed to explore the characteristics and risks of mucosal factors.
A total of 139 early gastric cancers (EGC) diagnosed in 133 patients after successful eradication from January 2016 to December 2021 were retrospectively included in the Hp-eradication EGC group and 170 EGCs diagnosed in 158 patients were included in the Hp-positive EGC group. We analyzed the clinical, pathological, and endoscopic characteristics between the two groups to identify the features of EGC after Hp eradication. Another 107 patients with no EGC after Hp eradication were enrolled in a Hp-eradication non-EGC group. The background mucosal factors between the Hp-eradication EGC group and the Hp-eradication non-EGC group were compared to analyze the high-risk background mucosal factors of EGC after eradication. In addition, we divided the EGC group after Hp eradication into IIc type and non-IIc type according to endoscopic gross classification to assess the high-risk background factors of IIc-type EGC after Hp eradication.
The endoscopic features of EGC after Hp eradication included location in the lower part of the stomach (=0.001), yellowish color (= 0.031), and smaller size (=0.001). The moderate/severe gastric atrophy (GA), intestinal metaplasia (IM) in the corpus, severe diffuse redness, and map-like redness were risk factors for EGC after eradication (=0.001, =0.001, =0.001, and = 0.005, respectively). The Kyoto classification total score in the EGC group was higher than the non-EGC group (4 vs.3 <0.001). A multivariate analysis revealed that depressed erosion (OR=3.42, 95% CI 1.35-8.65, = 0.009) was an independent risk factor for IIc-type EGC after Hp eradication.
EGC after eradication are smaller and yellowish lesions located in the lower part of the stomach. The risk background mucosal factors include moderate/severe GA, IM in the corpus, severe diffuse redness, and map-like redness. The Kyoto classification total score of 4 or more after successful eradication treatment might indicate EGC risk. In addition, the IIc-type EGC should be cautioned in the presence of depressed erosion after Hp eradication.
幽门螺杆菌（Hp）成功根除后仍会发生胃癌。在本研究中，我们旨在探讨黏膜因素的特征和风险。
回顾性纳入2016年1月至2021年12月期间133例患者成功根除Hp后诊断出的139例早期胃癌（EGC）作为Hp根除后EGC组，以及158例患者诊断出的170例EGC作为Hp阳性EGC组。我们分析了两组之间的临床、病理和内镜特征，以确定Hp根除后EGC的特征。另外107例Hp根除后未发生EGC的患者纳入Hp根除后非EGC组。比较Hp根除后EGC组和Hp根除后非EGC组之间的背景黏膜因素，以分析根除后EGC的高危背景黏膜因素。此外，我们根据内镜大体分类将Hp根除后的EGC组分为IIc型和非IIc型，以评估Hp根除后IIc型EGC的高危背景因素。
Hp根除后EGC的内镜特征包括位于胃下部（=0.001）、淡黄色（=0.031）和较小尺寸（=0.001）。中度/重度胃萎缩（GA）、胃体肠化生（IM）、重度弥漫性发红和地图样发红是根除后EGC的危险因素（分别为=0.001、=0.001、=0.001和=0.005）。EGC组的京都分类总分高于非EGC组（4比3，<0.001）。多因素分析显示，凹陷性糜烂（OR=3.42，95%CI 1.35-8.65，=0.009）是Hp根除后IIc型EGC的独立危险因素。
根除后EGC是位于胃下部的较小的淡黄色病变。高危背景黏膜因素包括中度/重度GA、胃体IM、重度弥漫性发红和地图样发红。成功根除治疗后京都分类总分达到4分或更高可能提示EGC风险。此外，Hp根除后存在凹陷性糜烂时应警惕IIc型EGC。
