Incomplete type of intestinal metaplasia has the highest risk to progress to gastric cancer: results of the Spanish follow-up multicenter study
Incomplete type of intestinal metaplasia has the highest risk to progress to gastric cancer: results of the Spanish follow-up multicenter study
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DOI：
10.1111/jgh.13249
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发表时间：
2016-05-01
影响因子：
4.1
通讯作者：
Gisbert, Javier P.
中科院分区：
文献类型：
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作者：
Gonzalez, Carlos A.;Miguel Sanz-Anquela, Jose;Gisbert, Javier P.
背景和目的在高或中危人群中，对有从胃前体病变（PL）进展为胃癌（GC）风险的患者进行定期监测是降低GC负担的最有效策略。不完全型肠上皮化生（IIM）可能被认为是最好的候选者，但仍有争议，需要更多的研究。为了进一步评估进展的亚型IM GC occurrence.MethodsA的预测进行了后续研究，包括649例患者，诊断PL之间的1995-2004年在9个参与医院从西班牙，谁重复活检在2011-2013年。通过问卷调查收集医疗信息和习惯。根据形态学，IM被细分为完全型（小肠型，CIM）和不完全型（结肠型，IIM）。分析使用考克斯（HR）models.ResultsAt基线，24%的患者有萎缩性胃炎，38%CIM，34%IIM，和4%异型增生。平均随访12年。随访期间，24例患者（3.7%）患上胃腺癌。CIM和IIM患者的GC发病率分别为2.76/1000人-年和5.76/1000人-年。在调整性别、年龄、吸烟、GC家族史和使用NSAIDs.ConclusionsIIM是进展为GC的最高风险的PL后，IIM与CIM基线相比，进展为CG的HR为2.75（95%CI 1.06-6.26）。IM的亚型分型是识别需要更密切监测的高风险患者的有效程序。
Background and AimIn high or moderate risk populations, periodic surveillance of patients at risk of progression from gastric precursor lesions (PL) to gastric cancer (GC) is the most effective strategy for reducing the burden of GC. Incomplete type of intestinal metaplasia (IIM) may be considered as the best candidate, but it is still controversial and more research is needed. To further assess the progression of subtypes of IM as predictors of GC occurrence.MethodsA follow-up study was carried-out including 649 patients, diagnosed with PL between 1995-2004 in 9 participating hospitals from Spain, and who repeated the biopsy during 2011-2013. Medical information and habits were collected through a questionnaire. Based on morphology, IM was sub-classified as complete (small intestinal type, CIM) and incomplete (colonic type, IIM). Analyses were done using Cox (HR) models.ResultsAt baseline, 24% of patients had atrophic gastritis, 38% CIM, 34% IIM, and 4% dysplasia. Mean follow-up was 12years. 24 patients (3.7%) developed a gastric adenocarcinoma during follow-up. The incidence rate of GC was 2.76 and 5.76 per 1,000 person-years for those with CIM and IIM, respectively. The HR of progression to CG was 2.75 (95% CI 1.06-6.26) for those with IIM compared with those with CIM at baseline, after adjusting for sex, age, smoking, family history of GC and use of NSAIDs.ConclusionsIIM is the PL with highest risk to progress to GC. Sub-typing of IM is a valid procedure for the identification of high risk patients that require more intensive surveillance.