| 吴秀贞,刘宗超,覃向向,李毅,张兰福,李哲轩,张阳,周彤,张婧莹,刘卫东,游伟程,潘凯枫,李文庆.基于胃癌高发区人群筛查队列的不同胃黏膜病变进展为胃癌风险的前瞻性研究[J].Chinese journal of Epidemiology,2022,43(12):1972-1978 |
| 基于胃癌高发区人群筛查队列的不同胃黏膜病变进展为胃癌风险的前瞻性研究 |
| The risk of incident gastric cancer for populations with different precancerous gastric lesions: a prospective follow-up study |
| Received:August 17, 2022 |
| DOI：10.3760/cma.j.cn112338-20220817-00716 |
| KeyWord: 胃癌 筛查 胃黏膜病变 |
| English Key Word: Gastric cancer Screening Precancerous gastric lesions |
| FundProject:山东省潍坊市卫生健康委员会科研基金（WFWSJK-2021-030）；国家自然科学基金（82273704）；国家重点研发计划（2018YFC1313105） |
| Author Name | Affiliation | E-mail | | Wu Xiuzhen | Linqu People's Hospital of Shandong Province, Linqu 262600, China | | | Liu Zongchao | Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing 100142, China | | | Qin Xiangxiang | Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing 100142, China | | | Li Yi | Linqu People's Hospital of Shandong Province, Linqu 262600, China | | | Zhang Lanfu | Linqu People's Hospital of Shandong Province, Linqu 262600, China | | | Li Zhexuan | Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing 100142, China | | | Zhang Yang | Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing 100142, China | | | Zhou Tong | Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing 100142, China | | | Zhang Jingying | Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing 100142, China | | | Liu Weidong | Institute for Gastric Cancer Prevention of Linqu of Shandong Province, Linqu 262600, China | | | You Weicheng | Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing 100142, China | | | Pan Kaifeng | Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing 100142, China | | | Li Wenqing | Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing 100142, China | wenqing_li@bjmu.edu.cn |
|
| Hits: 1625 |
| Download times: 552 |
| Abstract: |
| 目的 依托胃癌高发区大规模人群筛查队列分析不同级别胃黏膜病变的患病情况，前瞻性探讨不同胃黏膜病变进展为胃癌的风险，为优化胃癌的筛查策略提供科学依据。方法 基于山东省临朐县胃癌高发区开展的国家上消化道癌早诊早治项目，纳入年龄在40~69岁之间，2012-2018年经内镜筛查和病理诊断明确为各级别胃黏膜病变、且未患有高级别上皮内瘤变（HGIN）或浸润性胃癌的14 087例研究对象，随访至2019年12月31日。随访期内新发胃癌通过重复性胃镜筛查、肿瘤发病和死因登记系统报告以及主动入户随访联合判定，经查阅医院信息管理系统中摘抄的临床病历进行确认。应用Poisson回归模型计算各级别胃黏膜病变进展至胃癌风险的相对危险度（RR）及其95%CI。结果 14 087例研究对象中，胃黏膜正常者仅有8例（0.06%），最高诊断为浅表性胃炎（SG）、慢性萎缩性胃炎（CAG）、肠上皮化生（IM）和低级别上皮内瘤变（LGIN）分别为7 608例（54.00%）、2 848例（20.22%）、3 103例（22.03%）和520例（3.69%）。经过前瞻性随访，共有109例研究对象诊断为HGIN（63例）和浸润性胃癌（46例）。与基线正常或仅有SG的个体相比，患有CAG、IM和LGIN的个体进展为胃癌的风险依次增加为3.85倍（RR=3.85，95%CI：2.04~7.28）、5.18倍（RR=5.18，95%CI：2.79~9.60）和19.08倍（RR=19.08，95%CI：9.97~36.53），其中LGIN组进展为HGIN和浸润性胃癌的风险分别为SG/正常组的22.96倍（RR=22.96，95%CI：9.71~54.27）和14.64倍（RR=14.64，95%CI：5.37~39.93）。各个年龄组患有LGIN者随访期间发生胃癌的风险均显著增加。结论 基于胃癌高发区的大样本人群研究显示，绝大多数40~69岁的高发区居民患有不同程度胃黏膜病变。随胃黏膜病变严重程度的增加，随访期间发生胃癌的风险呈级联上升趋势。 |
| English Abstract: |
| Objective To provide evidence for optimizing the screening strategy for gastric cancer (GC), we evaluated the risk of incident GC for individuals with different precancerous gastric lesions in a prospective cohort study. Methods Based on the National Upper Gastrointestinal Cancer Early Detection Program launched in Linqu, Shandong, a high-risk area of gastric cancer in China, we included a total of 14 087 subjects diagnosed with different gastric lesions stages by endoscopic screening from 2012 to 2018. Study subjects were prospectively followed up until December 31, 2019. The incidence of GC during the follow-up was ascertained by repeated endoscopic examinations, cancer, death registry reports, and active follow-up of study subjects and was confirmed by reviewing medical records extracted from the hospital information management system. The Poisson regression model was applied to calculate the relative risk (RR) and 95%CI for GC occurrence among subjects with different gastric lesions. Results Among 14 087 subjects with different gastric lesions as determined by their first endoscopic examination in 2012-2018, 7 608 (54.00%) had a global diagnosis of superficial gastritis (SG), 2 848 (20.22%) had chronic atrophic gastritis (CAG), 3 103 (22.03%) had intestinal metaplasia (IM), and 520 (3.69%) had low-grade intestinal neoplasia (LGIN). During the follow-up, 109 subjects were diagnosed with GC, including 63 with high-grade intestinal neoplasia (HGIN) and 46 with invasive GC. Compared to subjects having normal gastric mucosa or SG, those with CAG (RR=3.85, 95%CI: 2.04-7.28), IM (RR=5.18, 95%CI: 2.79-9.60), and LGIN (RR=19.08, 95%CI: 9.97-36.53) had significantly increased risk of progression to GC. Individuals with these gastric lesions had an elevated risk of developing HGIN and invasive GC. For subjects with LGIN, the RR was 22.96 (95%CI: 9.71-54.27) for developing HGIN and 14.64 (95%CI: 5.37-39.93) for developing invasive GC. Subgroup analyses found that all age group subjects with LGIN diagnosed during the initial endoscopic examination had a significantly increased risk of developing the GC. Conclusions Our large-scale prospective study on a high-risk area of GC showed that most residents aged 40-69 years had gastric lesions of different stages. Subjects with more advanced gastric lesions had a significantly increased risk of progression to GC. |
|
View Fulltext
Html FullText
View/Add Comment Download reader |
| Close |
|
|
|