白光内镜下靶向活检在西藏地区藏族胃癌风险人群中的应用价值

Application value of white light endoscopic targeted biopsy in Tibetan gastric cancer risk population in Xizang region

摘要:

为了评估白光内镜下靶向活检在西藏地区藏族胃癌风险人群中的应用价值，前瞻性地招募了2022年6月至2023年12月在拉萨市人民医院消化内科就诊且经新型胃癌筛查评分系统评估为中、高危的666例藏族受试者，采用随机数字表法随机分为试验组（339例）和对照组（327例），试验组接受白光内镜下靶向活检，对照组接受白光内镜下传统活检。试验组有254例（74.9%）经白光内镜下靶向黏膜活检策略评估后行白光内镜下靶向活检，胃黏膜萎缩检出率［31.1%（79/254）比19.9%（65/327），χ2=9.66，P=0.002］和肠上皮化生检出率［22.4%（57/254）比15.9%（52/327），χ2=4.01，P=0.045］均明显高于对照组，早期胃癌检出率［7.5%（19/254）比4.0%（13/327），χ2=3.37，P=0.066］和进展期胃癌检出率［0.0%（0/254）比2.1%（7/327），P=0.617］与对照组比较差异均无统计学意义，活检部位数［3（2，4）点比5（5，5）点，Z=10.50，P<0.001］、活检次数［4（3，5）次比5（5，5）次，Z=8.43，P<0.001］、检查费用［1 444.05（1 211.20，1 775.98）元比1 529.47（1 351.73，1 777.48）元，Z=1.96，P=0.001］均明显少于对照组。试验组85例未活检者进行了为期12个月的随访，随访期内9例［2.7%（9/339）］出现黏膜萎缩，13例［3.8%（13/339）］出现肠上皮化生，无一例出现早期胃癌和进展期胃癌。提示对于西藏地区藏族胃癌风险人群，白光内镜下靶向活检在降低活检率的同时，能有效提高胃黏膜萎缩和肠上皮化生的检出率，且不会明显增加早期胃癌和进展期胃癌的漏诊率，可在临床上推广应用。

Abstract:

To assess the application value of white light endoscopic targeted biopsy in Tibetan gastric cancer risk population in Xizang region, a prospective study was conducted and a total of 666 Tibetan subjects were recruited who were assessed as medium or high risk by a novel gastric cancer screening scoring system at the Department of Gastroenterology, Lhasa People''s Hospital from June 2022 to December 2023. Patients were randomly divided into the experimental group (339 cases, underwent white light endoscopic targeted biopsy) and the control group (327 cases, underwent white light endoscopic traditional biopsy) using a random number table method. In the experimental group, 254 (74.9%) cases underwent white light endoscopic targeted mucosal biopsies after evaluation of the targeted mucosal biopsy strategy. The detection rates of gastric mucosal atrophy [31.1% (79/254) VS 19.9% (65/327), χ²=9.66, P=0.002] and intestinal metaplasia [22.4% (57/254) VS 15.9% (52/327), χ²=4.01, P=0.045] were significantly higher in the experimental group compared with the control group. The detection rates of early gastric cancer [7.5% (19/254) VS 4.0% (13/327), χ²=3.37, P=0.066] and advanced gastric cancer [0.0% (0/254) VS 2.1% (7/327), P=0.617] were not significantly different between the two groups. The number of biopsy sites [3 (2, 4) sites VS 5 (5, 5) sites, Z=10.50, P<0.001], the number of biopsy attempts [4 (3, 5) times VS 5 (5, 5) times, Z=8.43, P<0.001], and the examination costs [1 444.05 (1 211.20, 1 775.98) yuan VS 1 529.47 (1 351.73, 1 777.48) yuan, Z=1.96, P=0.001] were significantly lower in the experimental group than those in the control group. Among the 85 subjects in the experimental group who did not undergo biopsy, 9 cases [2.7% (9/339)] developed mucosal atrophy and 13 cases [3.8% (13/339)] developed intestinal metaplasia during a 12-month follow-up period, with no case of early or advanced gastric cancer. These findings suggest that for the Tibetan population at gastric cancer risk in the Tibet region, white light endoscopic targeted biopsy can effectively increase the detection rates of gastric mucosal atrophy and intestinal metaplasia while reduce biopsy rates, without significantly increasing the missed diagnosis rates of early and advanced gastric cancer. This approach can be promoted for clinical application.