慢性萎缩性胃炎发生胃癌的危险因素:一项长期随访研究

Risk factors for development of gastric cancer in chronic atrophic gastritis: A long-term follow-up study

目的回顾性调查了慢性萎缩性胃炎(chronicatrophic gastritis,CAG)患者在长期随访期间胃癌(gastric cancer,GC)的发生情况,并评估CAG发生GC的危险因素.方法本研究纳入了青岛大学附属医院2003年-2007年期间经胃镜及病理诊断为CAG并完成5年以上内镜随访的患者522例,记录患者的年龄、性别、胃黏膜病变程度、生存时间及生存状态,运用COX回归分析影响CAG发生GC的危险因素.结果在平均随访7.57年±1.74年后, 522例CAG患者中23例患者诊断为胃恶性肿瘤,发病率为4.41%(23/522),其中低分化腺癌11例,中分化腺癌7例,高分化腺癌2例,神经内分泌癌2例,恶性淋巴瘤1例.男性(P=0.030,HR=2.464),年龄大于55岁(P=0.021,HR=2.584),CAG伴肠上皮化生(P=0.014, HR=6.261), CAG伴轻至中度不典型增生(P=0.020, HR=6.504), CAG伴重度不典型增生(P=0.015, HR=22.314)为CAG发生GC的危险因素.结论男性、年龄大于55岁、胃黏膜病变程度为CAG发生GC的危险因素.伴有重度不典型增生的CAG为最重要的危险因素,确诊后建议早期内镜下治疗.

AIM To identify the risk factors for the development of gastric cancer(GC)in atrophic gastritis patients during a longterm follow-up.METHODS This study enrolled 522 chronic atrophic gastritis patients who underwent gastroscopy and pathological diagnosis and completed endoscopic follow-up for more than 5 years in the Affiliated Hospital of Qingdao University from 2003 to 2007.The following parameters were collected:age,gender,degree of gastric mucosal lesions,survival time,and survival status.Baseline clinical and histological features are analyzed as potential risk factors for the development of GC by Cox regression analysis.RESULTS After an average follow-up period of 7.57 years±1.74 years,23 of 522 patients with chronic atrophic gastritis were diagnosed with GC,with an incidence of 4.41%(23/522),of whom 11 had poorly differentiated adenocarcinomas,7 had moderately differentiated adenocarcinomas,2 had well differentiated adenocarcinomas,2 had neuroendocrine carcinoma,and 1 had malignant lymphoma.Male gender(P=0.030,HR=2.464),age>55 years(P=0.021,HR=2.584),CAG with intestinal metaplasia(P=0.014,HR=6.261),CAG with mild to moderate atypical hyperplasia(P=0.020,HR=6.504),and CAG with severe atypical hyperplasia(P=0.015,HR=22.314)were identified to be risk factors for the development of GC in patients with chronic atrophic gastritis.CONCLUSION Male gender,age>55 years,and the degree of gastric mucosal lesions are risk factors for GC in underlying mucosal atrophy.Patients with chronic atrophic gastritis with severe dysplasia are at the highest risk,and early endoscopic treatment is recommended after diagnosis.