Rugge M, Leandro G, Farinati F, Di Mario F, Sonego F, Cassaro M, Guido M, Ninfo V
Department of Pathology, University of Padova-ULSS, Italy.
Cancer. 1995 Aug 1;76(3):376-82. doi: 10.1002/1097-0142(19950801)76:3<376::aid-cncr2820760305>3.0.co;2-a.
Gastric epithelial dysplasia (GED) in metaplastic mucosa is considered the most advanced preinvasive lesion in the multistep morphogenesis of intestinal-type gastric cancer (GC). The rate of GED's evolution into GC is still under debate and probably is related to pathologic and clinical parameters other than the dysplasia itself. The aim of this study was to evaluate whether clinical aspects (sex and age) and/or morphologic variables (GED grade, coexisting atrophic gastritis) are relevant to the outcome of dysplasia, with a view toward initiating the establishment of a rational follow-up protocol for practical GED management.
Ninety-three patients harboring GED (G1: 56, G2:34, G3:18) were followed for more than 12 months according to a previously-agreed protocol. Regression, progression, or evolution into GC were detected for each grade of GED. Multivariate analysis was used to check the independence of clinical and pathologic variables in the progression of GED into more severe dysplastic lesions and/or as risk factors for evolution into GC.
Age, male sex, GED grade and grade of coexisting atrophic gastritis proved independent risk factors for GED progression, with no significant interactions. Only GED grade (G2 and G3) was significantly associated with carcinomatous evolution. In G1-GED, age and the grade of coexisting atrophy proved to be independent risk factors for carcinomatous evolution.
In G1-GED, more stringent follow-up should be recommended for older patients with coexisting high grade atrophic gastritis; stringent follow-up is always mandatory for G2-GED; and a surgical approach is justified in G3-GED.
化生黏膜中的胃上皮异型增生（GED）被认为是肠型胃癌（GC）多步骤形态发生中最严重的癌前病变。GED演变为GC的发生率仍存在争议，可能与异型增生本身以外的病理和临床参数有关。本研究的目的是评估临床因素（性别和年龄）和/或形态学变量（GED分级、并存萎缩性胃炎）是否与异型增生的转归相关，以期启动建立针对实际GED管理的合理随访方案。
93例患有GED的患者（G1：56例，G2：34例，G3：18例）按照先前商定的方案进行了超过12个月的随访。对每个GED分级检测其是否出现消退、进展或演变为GC。采用多变量分析来检验临床和病理变量在GED进展为更严重异型增生病变过程中的独立性，以及作为演变为GC的危险因素的独立性。
年龄、男性、GED分级和并存萎缩性胃炎的分级被证明是GED进展的独立危险因素，且无显著交互作用。只有GED分级（G2和G3）与癌变进展显著相关。在G1-GED中，年龄和并存萎缩的分级被证明是癌变进展的独立危险因素。
在G1-GED中，对于并存高级别萎缩性胃炎的老年患者应建议更严格的随访；对于G2-GED始终必须进行严格随访；对于G3-GED采取手术治疗是合理的。
