幽门螺杆菌阴性早期胃癌的内镜及临床病理特征分析

Endoscopic and clinicopathological features of Helicobacter pylori‑negative early gastric cancer

摘要:

目的 分析幽门螺杆菌（Helicobacter pylori，HP）阴性早期胃癌的内镜及临床病理特征。方法 回顾性收集在青岛大学附属医院2013年6月至2024年3月诊断为早期胃癌的患者资料，按照HP阴性胃癌诊断标准纳入病例，分析HP阴性早期胃癌内镜下表现及组织病理学特点。结果 698例早期胃癌患者中共有29例HP阴性胃癌，占同期早期胃癌的4.2%。发病年龄为（59.9±10.0）岁，女性（69.0%，20/29）多于男性（31.0%，9/29），体重指数≥24 kg/m2占69.0%（20/29），治疗方式中内镜黏膜下剥离术占89.7%（26/29）。29例患者有30处病灶，位于胃中部者居多（40.0%，12/30），其次是胃上部（36.7%，11/30），组织学类型中分化型占73.3%（22/30）。胃泌酸腺腺瘤（oxyntic gland adenoma，OGA）/胃底腺型胃癌（gastric adenocarcinoma of fundic‑gland type，GA‑FG）13处，7处位于胃上部，6处位于胃中部；胃底腺黏膜型胃癌（gastric adenocarcinoma of fundic‑gland mucosa type，GA‑FGM）2处，全部位于胃上部；OGA/GA‑FG及GA‑FGM白光内镜下表现为息肉样或小的黏膜下肿瘤样隆起，发白或发红病变均可见，表面有分支状扩张血管，OGA/GA‑FG中8处病灶边界线不清楚，GA‑FGM中2处边界线不清晰。小凹上皮型胃癌（gastric adenocarcinoma of foveolar‑type，GA‑FV）3处，胃上、中、下部各1处，2处白光内镜下表现为红色隆起型病灶。印戒细胞癌5处，1处位于胃上部、1处胃下部、3处胃中部，白光内镜下表现为平坦或浅凹陷、发白或发红病变，3处为边界清晰病灶。此外，幽门腺癌4处，低分化管状腺癌3处，后两者白光及窄带光成像内镜下表现与HP阳性早期胃癌无显著差别；未发现肠型腺癌。结论 HP阴性早期胃癌具有独特的内镜和临床病理特点，女性多见，分化型占比居多，胃中上部多见隆起型病灶，OGA/GA‑FG类型居多。

Abstract:

Objective To analyze the endoscopic and clinicopathological characteristics of Helicobacter pylori (HP)‑negative early gastric cancer (EGC). Methods A retrospective study was conducted on data of patients who were diagnosed as having EGC at the Affiliated Hospital of Qingdao University between June 2013 and March 2024. Cases meeting the diagnostic criteria for HP‑negative status were included. Endoscopic findings and histopathological features of HP‑negative EGC were systematically analyzed. Results Among 698 EGC patients, 29 (4.2%) were identified as HP‑negative. The age at diagnosis was 59.9±10.0 years, with marked female predominance (69.0%, 20/29 VS 31.0% males, 9/29). A body mass index ≥24 kg/m2 was observed in 69.0% (20/29). Regarding therapeutic approaches, endoscopic submucosal dissection was performed in 89.7% (26/29). Among the 29 patients with a total of 30 lesions, the majority were localized to the middle third of the stomach (40.0%, 12/30), or the upper third (36.7%, 11/30). Differentiated‑type accounted for 73.3% (22/30) among the histological types, including 13 oxyntic gland adenoma (OGA) / gastric adenocarcinoma of fundic‑gland type (GA‑FG) (upper third: 7; middle third: 6), and 2 gastric adenocarcinomas of fundic‑gland mucosa type (GA‑FGM) (both upper third). White‑light endoscopy revealed polypoid or small submucosal tumor‑like protrusions with whitish or erythematous discoloration and characteristic branching dilated vessels on the surface. Among the OGA/GA‑FG lesions, 8 exhibited indistinct demarcation lines (DL). Additionally, both GA‑FGM lesions demonstrated poorly defined DL. Three gastric adenocarcinomas of foveolar‑type (GA‑FV) were identified (upper/middle/lower third: 1 each), with 2 presenting as erythematous elevated masses. Five signet ring cell carcinomas (upper/middle/lower third: 1/3/1) exhibited flat or shallow depressed morphology with whitish or erythematous discoloration under white‑light endoscopy; 3 exhibited well‑demarcated borders. Four pyloric gland adenocarcinomas and three poorly differentiated tubular adenocarcinomas showed no significant differences in endoscopic features on white‑light and narrow‑band imaging compared to HP‑positive EGC. No intestinal‑type adenocarcinomas were identified. Conclusion HP‑negative EGC exhibit distinct endoscopic and clinicopathological characteristics, including female predominance and frequent differentiated histology, and upper/middle‑third localization of elevated lesions, primarily OGA/GA‑FG.