除菌后分化型与未分化型早期胃癌的临床特征分析

Differences in clinicopathological features between differentiated and undifferentiated early gastric cancer after Helicobacter pylori eradication

摘要:

目的 分析除菌后分化型和未分化型早期胃癌的临床特征，探究发生未分化型早期胃癌的危险因素。方法 回顾性分析2018年1月至2022年5月在北京友谊医院成功根除幽门螺杆菌（Helicobacter pylori，HP）1年后发现早期胃癌并行内镜黏膜下剥离术治疗的患者临床资料进行病例对照研究，分为分化型早期胃癌组和未分化型早期胃癌组，观察两组患者在基本信息、内镜特点和病理特征的区别，并用logistic回归分析除菌后未分化型胃癌发生的危险因素。结果 纳入152例患者，其中分化型早期胃癌143例，未分化型早期胃癌9例。除菌后分化型及未分化型早期胃癌患者在年龄、性别、高血压、2型糖尿病、高脂血症、吸烟史及胃癌家族史方面差异无统计学意义（P>0.05）；在内镜特点方面，除菌后未分化型早期胃癌平坦型及凹陷型病变多见［88.9%（8/9）］，而分化型以隆起型居多［56.6%（81/143），P=0.005］；未分化型早期胃癌更容易发生黏膜下层浸润［33.3%（3/9）比4.2%（6/143），P=0.010］和再发异时性胃癌［33.3%（3/9）比1.4%（2/143），P<0.001］。多因素logistic回归分析显示，女性（P=0.028，OR=14.24，95%CI：1.34~151.28）及平坦型病变（P=0.026，OR=48.96，95%CI：1.60~1 495.39）是未分化型早期胃癌发生的独立危险因素。结论 除菌后未分化型早期胃癌以平坦型和凹陷型更多见，容易发生黏膜下浸润和异时性胃癌。女性及平坦型病变是除菌后未分化型早期胃癌发生的独立危险因素。

Abstract:

Objective To compare clinicopathological features between differentiated and undifferentiated early gastric cancer (EGC) following successful Helicobacter pylori eradication and identify risk factors for undifferentiated EGC. Methods A retrospective case-control study was performed on data of patients who were found to have EGC and underwent endoscopic submucosal dissection one year after successful Helicobacter pylori eradication from January 2018 to May 2022 in Beijing Friendship Hospital. The patients were divided into differentiated EGC group and undifferentiated EGC group and all clinicopathological data were analyzed. Univariate and multivariate logistic analysis were performed to identify the risk factors for undifferentiated EGC. Results A total of 152 patients were included, among whom 143 had differentiated EGC and 9 had undifferentiated EGC. There was no difference between differentiated and undifferentiated EGC in age, gender, hypertension, type 2 diabetes, hyperlipemia, smoking or family history of gastric cancer (P>0.05). Flat/depressed-type lesions predominated in undifferentiated EGC [88.9% (8/9)] versus elevated-type in differentiated EGC [56.6% (81/143), P=0.005]. Submucosal invasion [33.3% (3/9) VS 4.2% (6/143), P=0.010] and metachronous gastric cancer [33.3% (3/9) VS 1.4% (2/143), P<0.001] were more common in the undifferentiated group. Multivariate logistic analysis identified female gender (P=0.028, OR=14.24, 95%CI:1.34-151.28) and flat-type (P=0.026, OR=48.96, 95%CI: 1.60-1 495.39) as independent risk factors for undifferentiated EGC. Conclusion Undifferentiated EGC after Helicobacter pylori eradication demonstrates higher rates of flat/depressed morphology, submucosal invasion, and metachronous lesions. Female gender and flat-type lesions are independent risk factors for undifferentiated histology.