引文著录:
张华颖, 黄鑫宇, 薛会光, 杨爱华, 孙学国, 刘希双. 慢性萎缩性胃炎发生胃癌的危险因素: 一项长期随访研究.
世界华人消化杂志
2018; 26(31): 1812-1817
Risk factors for development of gastric cancer in chronic atrophic gastritis: A long-term follow-up study
Hua-Ying Zhang, Xin-Yu Huang, Hui-Guang Xue, Ai-Hua Yang, Xue-Guo Sun, Xi-Shuang Liu
Hui-Guang Xue, Xue-Guo Sun, Xi-Shuang Liu,
Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao 266100, Shandong Province, China
Ai-Hua Yang,
Department of Clinical Laboratory, the Affiliated Hospital of Qingdao University, Qingdao 266100, Shandong Province, China
Correspondence to
: Hui-Guang Xue, Associate Professor, Department of Gastroenterology, the Affiliated Hospital of Qingdao University, 59 Haier Road, Qingdao 266100, Shandong Province,
China. [email protected]
Received:
August 22, 2018
Revised:
September 27, 2018
Accepted:
October 19, 2018
Published online:
November 8, 2018
AIM
To identify the risk factors for the development of gastric cancer (GC) in atrophic gastritis patients during a long-term 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 adeno-carcinomas, 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.
Ferlay J
, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008.
Int J Cancer
. 2010;
127
:2893-2917.
[
PubMed
]
[
DOI
]
Borie F, Rigau V, Fingerhut A, Millat B; French Association for Surgical Research
. Prognostic factors for early gastric cancer in France: Cox regression analysis of 332 cases.
World J Surg
. 2004;
28
:686-691.
[
PubMed
]
[
DOI
]
Jin X
, Zhu Z, Shi Y. Metastasis mechanism and gene/protein expression in gastric cancer with distant organs metastasis.
Bull Cancer
. 2014;
101
:E1-12.
[
PubMed
]
[
DOI
]
Allemani C
, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, Bannon F, Ahn JV, Johnson CJ, Bonaventure A. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2).
Lancet
. 2015;
385
:977-1010.
[
PubMed
]
[
DOI
]
Chung SJ
, Park MJ, Kang SJ, Kang HY, Chung GE, Kim SG, Jung HC. Effect of annual endoscopic screening on clinicopathologic characteristics and treatment modality of gastric cancer in a high-incidence region of Korea.
Int J Cancer
. 2012;
131
:2376-2384.
[
PubMed
]
[
DOI
]
Hamashima C
, Ogoshi K, Okamoto M, Shabana M, Kishimoto T, Fukao A. A community-based, case-control study evaluating mortality reduction from gastric cancer by endoscopic screening in Japan.
PLoS One
. 2013;
8
:e79088.
[
PubMed
]
[
DOI
]
Wiseman M
. The second World Cancer Research Fund/American Institute for Cancer Research expert report. Food, nutrition, physical activity, and the prevention of cancer: a global perspective.
Proc Nutr Soc
. 2008;
67
:253-256.
[
PubMed
]
[
DOI
]
Torre LA
, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012.
CA Cancer J Clin
. 2015;
65
:87-108.
[
PubMed
]
[
DOI
]
Chen J
, Gong TT, Wu QJ. Parity and gastric cancer risk: a systematic review and dose-response meta-analysis of prospective cohort studies.
Sci Rep
. 2016;
6
:18766.
[
PubMed
]
[
DOI
]
韩 雪
, 赵 佳, 黄 辰曦, 谢 梦, 丁 一波, 马 立业, 张 宏伟, 曹 广文. 2002~2012年上海市杨浦区原发性胃癌发病及生存情况分析.
中华临床医师杂志(电子版)
. 2013;
7
:8169-8175.
[
PubMed
]
[
DOI
]
Leung WK
, Lin SR, Ching JY, To KF, Ng EK, Chan FK, Lau JY, Sung JJ. Factors predicting progression of gastric intestinal metaplasia: results of a randomised trial on Helicobacter pylori eradication.
Gut
. 2004;
53
:1244-1249.
[
PubMed
]
[
DOI
]
De Vries AC
, Van Grieken NCT, Looman CWN, Casparie MK, De Vries E, Meijer GA, Kuipers EJ. Gastric cancer risk in patients with premalignant gastric lesions: A nationwide cohort study in the Netherlands.
Gastroenterology
. 2008;
134
:945-952.
[
PubMed
]
[
DOI
]
de Vries AC
, Haringsma J, Kuipers EJ. The detection, surveillance and treatment of premalignant gastric lesions related to Helicobacter pylori infection.
Helicobacter
. 2007;
12
:1-15.
[
PubMed
]
[
DOI
]
Correa P
. Human gastric carcinogenesis: a multistep and multifactorial process--First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention.
Cancer Res
. 1992;
52
:6735-6740.
[
PubMed
]
[
DOI
]
Fox JG
, Wang TC. Inflammation, atrophy, and gastric cancer.
J Clin Invest
. 2007;
117
:60-69.
[
PubMed
]
[
DOI
]
Stolte M
. The new Vienna classification of epithelial neoplasia of the gastrointestinal tract: advantages and disadvantages.
Virchows Arch
. 2003;
442
:99-106.
[
PubMed
]
[
DOI
]
Dixon MF
. Gastrointestinal epithelial neoplasia: Vienna revisited.
Gut
. 2002;
51
:130-131.
[
PubMed
]
[
DOI
]
Steele SR
, Johnson EK, Champagne B, Davis B, Lee S, Rivadeneira D, Ross H, Hayden DA, Maykel JA. Endoscopy and polyps-diagnostic and therapeutic advances in management.
World J Gastroenterol
. 2013;
19
:4277-4288.
[
PubMed
]
[
DOI
]
Kikuchi D
, Iizuka T, Hoteya S, Yamada A, Furuhata T, Yamashita S, Domon K, Nakamura M, Matsui A, Mitani T. Usefulness of magnifying endoscopy with narrow-band imaging for determining tumor invasion depth in early gastric cancer.
Gastroenterol Res Pract
. 2013;
2013
:217695.
[
PubMed
]
[
DOI
]
