内镜下萎缩性胃炎分级对胃癌筛查的指导价值

Value of Endoscopic Atrophic Gastritis Grading for Screening of Gastric Cancer

背景:普及胃镜筛查是提高早期胃癌诊断率的有效途径。为使筛查更有效率,筛查时间间隔应根据胃癌风险分层决定。目的:探讨通过内镜下萎缩性胃炎分级能否确定胃癌风险分层。方法:纳入2015年1月—2019年12月在中国人民解放军联勤保障部队第900医院至少接受过2次胃镜检查的患者,记录人口学资料和胃镜检查信息。采用木村-竹本分类法对内镜下萎缩性胃炎进行分级,根据分级结果将患者分为轻度组(无萎缩和C-1)、中度组(C-2、C-3)和重度组(O-1及以上),分析内镜分级与胃癌发生风险之间的相关性。结果:共8736例患者纳入研究,轻、中、重度组分别为4154例(47.6%)、2409例(27.6%)和2173例(24.9%);平均胃镜随访时间为(1052±643)d,两次胃镜检查平均间隔时间为(518±271)d。内镜诊断与病理诊断萎缩性胃炎的总体符合率为88.9%。胃镜随访中共发现41例胃癌,胃癌检出率由轻度组至中、重度组依次递增(0.07%、0.54%和1.15%,P<0.001)。结论:基于内镜下萎缩性胃炎分级可对患者进行胃癌风险分层,指导制订个体化的胃镜随访间期。

Background:Endoscopic screening is an effective approach for detecting early gastric cancer.The interval of endoscopic surveillance should be defined based on the risk stratification of gastric cancer,so as to improve the screening efficiency.Aims:To investigate whether gastric cancer risk could be stratified according to endoscopic atrophic gastritis grading.Methods:Subjects who underwent gastroscopy at least two times between Jan.2015 and Dec.2019 at the 900th Hospital of Joint Logistics Support Force,PLA were enrolled in a retrospective study.The demographic data and information on endoscopy were recorded.The extent and degree of gastric atrophy under endoscopy was graded using Kimura-Takemoto classification system.Then the subjects were allocated into mild group(none atrophy and C-1),moderate group(C-2 and C-3)and severe group(O-1,O-2 and O-3)based on the grading.The correlation of endoscopic grading of atrophy with the risk of gastric cancer was analyzed.Results:A total of 8736 subjects were enrolled,4154 were in mild group(47.6%),2409 in moderate group(27.6%),and 2173 in severe group(24.9%).The mean endoscopic follow-up time was(1052±643)d,and the mean endoscopic surveillance interval was(518±271)d.The overall coincidence rate of endoscopic diagnosis and pathological diagnosis for atrophy was 88.9%.During the follow-up period,gastric cancer was detected in 41 cases;the detection rates of mild group,moderate group and severe group were 0.07%,0.54%and 1.15%,respectively(P<0.001).Conclusions:The risk of gastric cancer can be stratified according to the endoscopic atrophic gastritis grading,which is helpful for the decision of individualized endoscopic surveillance interval.