同时性多发早期胃癌的相关风险因素和临床病理特征

Risk factors and clinicopathologic characteristics of synchronous multiple early gastric neoplasms

目的:分析总结同时性多发早期胃癌(synchronous multiple early gastric cancer,SMEGC)的相关风险因素和临床病理特征,帮助临床医师提高SMEGC的检出率。方法:回顾性收集2014年6月—2018年12月于南京医科大学第一附属医院诊断并接受内镜下黏膜剥离术(endoscopic mucosal dissection,ESD)治疗的早期胃癌(early gastric cancer,EGC)或高级别上皮内瘤变(high-grade intraepithelial neoplasia,HGIN)患者数据,共517例纳入研究。结果:35例(6.8%)被诊断为SMEGC。发现男性(P=0.028)、慢性萎缩性胃炎(P=0.024)和中重度肠化生(P=0.048)是SMEGC的独立危险因素。而且,SMEGC患者和单发肿瘤患者的生存率没有显著差异(P=0.976)。此外,根据Moertel标准区别主、副病灶,主病灶和副病灶的大小呈显著正相关(r=0.779,P=0.001)。主、副病灶内镜下大体分型的一致率为51%(P=0.02)。结论:针对有慢性萎缩性胃炎或中重度肠化生的男性SMEGC高风险人群,内窥镜医师需要更加细致地检查,并对主、副病灶间的联系有充分认识,才能避免遗漏SMEGC病灶。

Objective:This study aims to investigated and summarized the risk factors and clinicopathological characteristics of synchronous multiple early gastric cancer(SMEGC)to help clinicians improve the detection rate of SMEGC.Methods:Medical records of patients with early gastric cancer(EGC)or high-grade intraepithelial neoplasia(HGIN)wete retrospectively reviewed form June2014 to December 2018.In total,517 patients were included.Results:SMEGC was diagnosed in 35 patients(6.8%).Male(P=0.028),chronic atrophy gastritis(P=0.024),and moderate to severe intestinal metaplasia(P=0.048)were independent risk factors for the SMEGC.Also,there were no significant differences in survival rates between patients with SMEGC and patients with single neoplasm(P=0.976).Further,main or minor lesions were defined according to Moertel standard.Main and minor lesions showed significant positive correlation in size(r=0.779,P=0.001).Macroscopic types were identical in 51%(P=0.02)between main lesions and minor lesions.Conclusion:Therefore,the endoscopic physicians need a more meticulous endoscopic examination and find the possibility of SMEGC considering characteristics of main and minor lesions.