Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan.
Department of Endoscopy, Shimane University Hospital, 89-1 Enya, Izumo, 693-8501, Japan.
J Gastroenterol. 2024 Jan;59(1):1-10. doi: 10.1007/s00535-023-02050-2. Epub 2023 Oct 19.
The incidence of gastric neoplasms in Helicobacter pylori (Hp)-naïve patients has recently increased due to a remarkable decrease in the Hp-infected population in Japan. We investigated the clinicopathologic differences between Hp-infected gastric neoplasms (HpIGNs) and Hp-naïve gastric neoplasms (HpNGNs) that have not been fully elucidated so far.
This retrospective multicenter study investigated 966 consecutive patients with 1131 gastric dysplasia or cancers who underwent endoscopic or surgical treatment for the recent decade. Clinicopathologic features were compared between HpIGN and HpNGN cases.
One thousand and sixty-eight HpIGNs in 916 patients included 877 differentiated types and 191 undifferentiated types. Sixty-three HpNGNs in 50 patients included 57 differentiated types (35 foveolar types, 15 intestinal types, 6 fundic-gland types, and 1 other differentiated type) and 6 undifferentiated types. HpNGNs occurred in younger (59.5 vs. 71.8 years, p < 0.05) and female patients (40.0% vs. 26.5%, p < 0.05), were found more frequently in the proximal compartment (p < 0.05), and had smaller size (median 4.0 vs. 20.0 mm, p < 0.05). Histologically, HpNGNs and HpIGNs both primarily consisted of differentiated type (90.5% vs. 82.1%, p = 0.089) and HpNGNs showed lower prevalence of invasive cancer (11.1% vs. 37.6%, p < 0.05) and lymphovascular invasion (1.6% vs. 31.6%, p < 0.05). Nearly all HpNGNs (62/63, 98.4%) were diagnosed in early pathological stage, while 16.1% (172/1068) of HpIGNs were diagnosed in advanced stage (p < 0.05).
HpNGNs is recently on the increase but shows lower malignant nature regardless of histologic type than HpIGN. Endoscopic gastric cancer screening will be reviewed via cost effectiveness for Hp-naïve individuals in future.
由于日本 Hp 感染人群的显著减少，最近 Hp 阴性患者的胃肿瘤发病率有所增加。我们研究了迄今为止尚未充分阐明的 Hp 感染性胃肿瘤（HpIGN）和 Hp 阴性胃肿瘤（HpNGN）之间的临床病理差异。
这项回顾性多中心研究调查了最近十年接受内镜或手术治疗的 966 例 1131 例胃发育不良或癌症患者。比较了 HpIGN 和 HpNGN 病例的临床病理特征。
916 例患者中有 1068 例 HpIGN，包括 877 例分化型和 191 例未分化型。50 例患者中有 63 例 HpNGN，包括 57 例分化型（35 例胃小凹型、15 例肠型、6 例胃底腺型和 1 例其他分化型）和 6 例未分化型。HpNGN 患者年龄较小（59.5 岁 vs. 71.8 岁，p < 0.05），女性患者较多（40.0% vs. 26.5%，p < 0.05），更多见于近端部位（p < 0.05），肿瘤体积较小（中位数 4.0 毫米 vs. 20.0 毫米，p < 0.05）。组织学上，HpNGN 和 HpIGN 主要由分化型组成（90.5% vs. 82.1%，p = 0.089），而 HpNGN 的侵袭性癌（11.1% vs. 37.6%，p < 0.05）和血管淋巴管浸润（1.6% vs. 31.6%，p < 0.05）发生率较低。几乎所有的 HpNGN（62/63，98.4%）都被诊断为早期病理阶段，而 HpIGN 中只有 16.1%（172/1068）被诊断为晚期（p < 0.05）。
尽管无论组织学类型如何，HpNGN 的恶性程度都低于 HpIGN，但最近其发病率有所上升。未来，对于 Hp 阴性个体，将通过成本效益来审查内镜胃癌筛查。
