Gastric cancer in autoimmune gastritis: A case-control study from the German centers of the staR project on gastric cancer research
Gastric cancer in autoimmune gastritis: A case-control study from the German centers of the staR project on gastric cancer research
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DOI：
10.1177/2050640619891580
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发表时间：
2019-11-26
影响因子：
6
通讯作者：
Venerito, Marino
中科院分区：
文献类型：
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作者：
Weise, Friederike;Vieth, Michael;Venerito, Marino
目的：自身免疫性胃炎（AIG）患者发生胃癌（GC）的风险增加。在这项研究中，我们通过一项多中心病例对照研究来评估GC合并AIG患者的特征和结局。方法在2013年4月至2017年5月期间，招募胃癌患者，包括食管胃交界处癌（EGJ） Siewert II型和III型。鉴别出具有AIG组织学特征的患者，并将其与无AIG的GC患者按年龄和性别1:2进行匹配。使用自我管理的问卷记录出现的症状。结果572/759例胃癌患者进行了胃黏膜组织学检查。总体而言，28例（4.9%）GC患者有AIG（67 +/- 9年，男女比1.3:1）。在AIG患者中，胃癌更可能局限于胃近端（即EGJ、眼底、胃体）（优势比（OR） 2.7, 95%可信区间（CI） 1.0-7.1）。在GC合并AIG的患者中，恶性贫血是主要的临床体征（OR 22.0, 95% CI 2.6-187.2），也是食管胃十二指肠镜检查最常见的适应症（OR 29.0, 95% CI 7.2-116.4）。伴有AIG的胃癌患者更有可能没有远处转移（OR 6.2, 95% CI 1.3-28.8），并且更有可能获得治疗意向（OR 3.0, 95% CI 1.0-9.0）。有和没有AIG的GC患者的5年生存率（95% CI）分别为84.7%（83.8-85.6）和53.5% (50.9-56.1)（OR 0.25, 95% CI 0.08-0.75, p = 0.001）。结论恶性贫血可使AIG患者早期诊断为胃癌，提高临床预后。
Objectives Patients with autoimmune gastritis (AIG) are reported to have an increased risk of developing gastric cancer (GC). In this study, we assess the characteristics and outcomes of GC patients with AIG in a multicenter case-control study. Methods Between April 2013 and May 2017, patients with GC, including cancers of the esophagogastric junction (EGJ) Siewert type II and III, were recruited. Patients with histological characteristics of AIG were identified and matched in a 1:2 fashion for age and gender to GC patients with no AIG. Presenting symptoms were documented using a self-administered questionnaire. Results Histological assessment of gastric mucosa was available for 572/759 GC patients. Overall, 28 (4.9%) of GC patients had AIG (67 +/- 9 years, female-to-male ratio 1.3:1). In patients with AIG, GC was more likely to be localized in the proximal (i.e. EGJ, fundus, corpus) stomach (odds ratio (OR) 2.7, 95% confidence interval (CI) 1.0-7.1). In GC patients with AIG, pernicious anemia was the leading clinical sign (OR 22.0, 95% CI 2.6-187.2), and the most common indication for esophagogastroduodenoscopy (OR 29.0, 95% CI 7.2-116.4). GC patients with AIG were more likely to present without distant metastases (OR 6.2, 95% CI 1.3-28.8) and to be treated with curative intention (OR 3.0, 95% CI 1.0-9.0). The five-year survival rates with 95% CI in GC patients with and with no AIG were 84.7% (83.8-85.6) and 53.5% (50.9-56.1), respectively (OR 0.25, 95% CI 0.08-0.75, p = 0.001). Conclusions Pernicious anemia leads to earlier diagnosis of GC in AIG patients and contributes significantly to a better clinical outcome.