Abe Ryo, Uchikoshi Shu, Horikawa Yohei, Mimori Nobuya, Kato Yuhei, Tahata Yuta, Fushimi Saki, Saito Masahiro, Takahashi Satsuki
Department of Gastroenterology, Hiraka General Hospital, Yokote 013-8610, Akita, Japan.
Department of Gastroenterology, Graduate School of Medicine, Akita University, Akita 010-8543, Akita, Japan.
Cancers (Basel). 2024 Dec 13;16(24):4153. doi: 10.3390/cancers16244153.
BACKGROUND/OBJECTIVES: Since 2013, eradication therapy for gastritis (-ET) has been covered by the National Health Insurance of Japan. Recently, the risk of post-eradication gastric cancer (pE-GC) has increased. pE-GC includes cancers that develop immediately and several years after -ET. Therefore, we aimed to clarify the endoscopic and histological characteristics of late types of pE-GCs.
One hundred patients with differentiated cancers detected after -ET who underwent endoscopic submucosal dissection from 2015 to 2023 were compared. Patients were divided into two groups; the immediate group (n = 69), with cancer detected within 6 years, and the delayed group (n = 31), with cancer detected within >6 years after -ET. The background mucosa and tumor mucosa were examined individually. The endoscopic findings were as follows: enlarged folds, map-like redness, intermediate zone irregularity, and the presence of a regular arrangement of collecting venules and a light blue crest (background); an irregular surface structure, an irregular vascular pattern, an irregular surface pattern, and a gastritis-like appearance (tumor). The histological findings were as follows: a low remnant rate of the fundic glands, intestinal metaplasia (IM), crypt enlargement, and neutrophil infiltration (background); mosaicism, the elongation of noncancer ducts, and an overlying non-neoplastic epithelium (tumor).
There was no significant difference regarding the background mucosa and tumor mucosa between the two groups. In the delayed group, the remnant rate of the fundic glands was 19.8 ± 15.6%, and IM was 87.1% (27/31). Further, 90.3% (28/31) of the patients exhibited persistent neutrophil infiltration.
This study suggested that patients with a low remnant rate of the fundic gland and IM and persistent mucosal inflammation were at high risk for developing pE-GCs.
背景/目的：自2013年以来，日本国民健康保险已涵盖胃炎根除治疗（-ET）。最近，根除后胃癌（pE-GC）的风险有所增加。pE-GC包括-ET后立即发生和数年后发生的癌症。因此，我们旨在阐明晚期pE-GC的内镜和组织学特征。
比较了2015年至2023年接受内镜黏膜下剥离术的100例-ET后检测出分化型癌症的患者。患者分为两组；即时组（n = 69），癌症在6年内检测到，延迟组（n = 31），癌症在-ET后>6年内检测到。分别检查背景黏膜和肿瘤黏膜。内镜检查结果如下：皱襞增大、地图样发红、中间区不规则以及存在集合小静脉规则排列和浅蓝色嵴（背景）；表面结构不规则、血管形态不规则、表面图案不规则和胃炎样外观（肿瘤）。组织学检查结果如下：胃底腺残留率低、肠化生（IM）、隐窝增大和中性粒细胞浸润（背景）；镶嵌现象、非癌性导管延长和覆盖的非肿瘤上皮（肿瘤）。
两组之间的背景黏膜和肿瘤黏膜无显著差异。在延迟组中，胃底腺残留率为19.8±15.6%，IM为87.1%（27/31）。此外，90.3%（28/31）的患者表现出持续性中性粒细胞浸润。
本研究表明，胃底腺残留率低、IM以及持续性黏膜炎症的患者发生pE-GC的风险较高。
