深在性囊性胃炎的临床特点及合并胃癌的危险因素分析

Clinical features of gastritis cystica profunda and risk factors of its coexistence with gastric cancer

摘要:

目的 探讨深在性囊性胃炎（gastritis cystica profunda，GCP）的临床特点及合并胃癌的危险因素。方法 回顾性分析2015年1月至2022年3月期间149例在复旦大学附属中山医院病理确诊为GCP的患者资料，其中106例为内镜下切除后病理确诊GCP，另43例为外科术后病理诊断GCP。149例GCP患者中，单纯GCP组56例，GCP合并胃癌组93例。对患者基本信息、临床资料、病变形态和病理结果进行分析。结果 单纯GCP组56例患者中，男性占62.5%（35/56），平均年龄58.8岁，胃上段（贲门胃底部）占51.8%（29/56），形态以息肉样隆起型（41.1%，23/56）和黏膜下隆起型（35.7%，20/56）多见，临床症状不典型。GCP合并胃癌组93例患者中，男性占90.3%（84/93），平均年龄66.9岁，胃上段占75.3%（70/93），组织学类型以分化型癌为主（91.4%，85/93）。GCP合并早期胃癌者76例，形态以黏膜病变型为主（73.7%，56/76），临床症状不典型；GCP合并进展期胃癌者17例，形态以隆起溃疡型为主（88.2%，15/17），多因腹痛及黑便就诊（100.0%，17/17）。二分类logistic回归分析显示，男性（P=0.004，OR=4.411，95%CI：1.621~12.002）、年龄（P=0.001，OR=1.085，95%CI：1.036~1.136）、形态为黏膜病变型（P<0.001，OR=5.080，95%CI：2.162~11.939）为GCP合并胃癌的危险因素，而是否发生在胃上段与合并胃癌无关（P=0.430，OR=0.707，95%CI：0.299~1.672）。106例内镜下切除患者中，GCP合并早期胃癌者57例，内镜下病灶中位长径2.50 cm；单纯GCP者49例，病灶中位长径1.20 cm，差异有统计性意义（Z=-5.503，P<0.001）。内镜下治疗患者中，胃上段GCP合并早期胃癌均为贲门部癌，多为表浅隆起伴凹陷型（0⁃Ⅱa+Ⅱc）（44.7%，21/47）。GCP合并胃癌患者内镜切除后评级为治愈性切除（eCuraA）占75.4%（43/57），内镜切除后追加外科手术者均无淋巴结转移。149例GCP患者中有胃部手术史者8例，有食管癌病史者7例，胃部多发肿瘤性病变者10例。结论 GCP好发于胃上段，与是否合并胃癌无关，但合并胃癌时多见于老年男性，早期形态多为黏膜病变型，组织学类型多为分化型癌。GCP可伴发食管或者胃的其他部位癌变，考虑GCP更倾向为一种伴癌病变。GCP合并胃癌的内镜下治愈性切除占比高，淋巴转移率低，故内镜下治疗是一种安全有效的途径。

Abstract:

Objective To analyze the clinical features of gastritis cystica profunda (GCP) and investigate the risk factors associated with its coexistence with gastric cancer. Methods Data of 149 patients with pathologically confirmed GCP at Zhongshan Hospital of Fudan University between January 2015 and March 2022 were retrospectively analyzed for basic information, clinical data, lesion manifestations and pathological results, of which 106 were pathologically confirmed GCP after endoscopic resection and 43 others were pathologically confirmed GCP after surgical procedures. Among 149 patients, 56 were in the simple GCP group, and 93 in the GCP combined with gastric cancer group. Results In the simple GCP group of 56 patients, 62.5% (35/56) were male and the mean age was 58.8 years. The predominant site of involvement was in the upper gastric segment (cardia and fundus) (51.8%,29/56), with manifestations primarily of the polypoid bulge type (41.1%,23/56) and submucosal bulge type (35.7%,20/56). Clinical symptoms were mostly atypical. In the group where GCP was combined with gastric cancer (93 cases), males accounted for 90.3% (84/93), the median age was 66.9 years, the upper gastric segment was predominantly affected (75.3%, 70/93), with differentiated cancer being the most common histological type (91.4%, 85/93). For 76 cases of early gastric cancer combined with GCP, mucosal lesions were the main presentation (73.7%, 56/76) with atypical clinical symptoms. Furthermore, in 17 cases of progressive gastric cancer combined with GCP, the manifestations were mainly bulging ulcers (88.2%, 15/17), and most of them were referred to the doctor because of abdominal pain and black stools (100.0%, 17/17). Binary logistic regression analysis showed that being male (P=0.004, OR=4.411, 95%CI: 1.621-12.002), age (P=0.001, OR=1.085, 95%CI: 1.036-1.136) and endoscopic manifestations of mucosal lesions (P<0.001, OR=5.080, 95%CI: 2.162-11.939) were risk factors for GCP combined with gastric cancer, but involvement of the upper gastric segment was not related to combination with gastric cancer (P=0.430, OR=0.707, 95%CI: 0.299-1.672). Among 106 patients with endoscopic resection, 57 cases of early gastric cancer combined with GCP had a median lesion length of 2.50 cm; 49 cases of GCP alone had a median lesion length of 1.20 cm, with significant difference (Z=-5.503, P<0.001). All upper gastric GCP combined with early gastric cancer in endoscopically treated patients were cancers of the cardia, most of which were superficial elevation with the concave type (0-Ⅱa+Ⅱc) (44.7%, 21/47). 75.4% (43/57) patients with gastric cancer combined with GCP were graded as curative resection (eCuraA) after endoscopic surgery , and none of those who had additional surgery after endoscopic surgery had lymph node metastasis. There were 8 cases with history of gastric surgery, 7 of esophageal cancer, and 10 of multiple neoplastic gastric lesions in the 149 patients with GCP. Conclusion GCP often occurs in the upper gastric region and is not inherently associated with the presence of gastric cancer. However, when coexisting with gastric cancer, it tends to affect elderly men, present with mucosal lesions of a differentiated histological type, and may be accompanied by esophageal or other gastric cancers. Notably, GCP is frequently identified as para-cancerous lesion, and endoscopic treatment emerges as a safe and effective approach, characterized by a high rate of curative endoscopic resections and a low incidence of lymphatic metastases.