安徽省歙县近10年早期胃癌筛查状况及临床病理特点分析

Screening Status and Clinicopathological Characteristics of Early Gastric Cancer in She County,Anhui Province in Recent 10 Years

目的:探讨歙县近10年早期胃癌筛查状况及其临床病理特点。方法:收集歙县人民医院病理科2011年1月至2020年12月接收的早期胃癌72例,以同期接收治疗的所有(382例)进展期胃癌做为对照组。观察2组临床病理特点的同异性,分析本地区早期胃癌的区域发病特点和筛查状况。进一步将72例早癌分为T1a和T1b两组,比较临床病理的差异性。结果:歙南(高盐饮食)地区胃癌发生率(17.2例/10万)高于非歙南地区(8.3例/10万)。歙南早癌占该地区胃癌的13.9%(47/337),低于非歙南的21.4%(25/117),但差异无统计学意义。早癌和进展期癌男女比例分别为2.5∶1.0(51/21)和3.24∶1.0(292/90)。近端早癌占比远低于近端进展癌占比,差异具有统计学意义。采用规范性筛查后,早癌年均检出例数从之前的6.1例上升到11.5例,早癌占比均超过20%。肿瘤大小、淋巴结转移和脉管内癌栓发生率在T1a和T1b肿瘤有差异性。肿瘤最大径、Nakamura分型和脉管内癌栓是淋巴结转移的危险因素。结论:歙南地区胃癌高发,早期胃癌绝对病例多,但相对检出率低,是今后筛查的重点区域。贲门早癌占比少,是需要加强观察的部位。相比于T1b,T1a肿瘤小、淋巴结转移和脉管内癌栓发生率低,适合选择内镜微创切除作为患者治疗的首选方案。

Objective:To investigate the screening status and clinicopathological features of early gastric cancer(EGC)in She County in the last decade.Methods:Data of 72 EGC patients from January 2011 to December 2020 were collected from the department of pathology of the People’s Hospital of She County.Another 382 cases of progressive gastric cancer which were treated during the same period were collected as the control group.According to the clinicopathological characteristics in two groups,incidence and screening of EGC were analyzed.72 cases of EGC were divided into two groups(T1a,T1b),and the clinicopathological differences were compared between groups.Results:The southern area with high salt diet exceeded other other areas of She County in the incidence of gastric cancer(17.2/100,000 vs 8.3/100,000).Early cancers in the latter[13.9%(47/337)]surpassed that in the former[21.4%(25/117)],but the difference was not statistically significant.The male to female ratio of early cancers and progressive cancers were 2.5∶1.0(51/21)and 3.24∶1.0(292/90).The incidence of early upper gastric cancer was significantly higher than that of progressive upper gastric cancer.After normative standard screening,the annual average early cancer cases increased from 6.1 to 11.5,accounting for over 20%of all cancers.T1a and T1b tumors were different in size,lymph node metastasis,and incidence of intravascular emboli.Tumor size,Nakamura type and intravascular emboli were risk factors for lymph node metastasis.Conclusion:There is a high incidence of gastric cancer in south of She County.The incidence of early gastric cancer is high,but the detection rate is low,indicating a key area for future screening.The cardia of the stomach,with a low proportion,is the site that need more attention.Compared with T1b tumors,the T1a tumors are smaller in size,lower in incidence rates of lymph node metastasis and intravascular tumor embolism,so minimally invasive endoscopic resection is preferable for patients with T1a tumors.