胃腺瘤性息肉的内镜和病理特点及癌变的危险因素分析

doi:10.19723/j.issn.1671-167X.2021.06.019

摘要/Abstract

摘要：

目的:分析胃腺瘤性息肉的内镜和病理特点,探讨其癌变的危险因素。方法:回顾性总结北京大学第三医院2005年1月1日至2019年12月31日的胃腺瘤性息肉患者的内镜和病理特点,并分析癌变的危险因素。结果:共纳入胃腺瘤性息肉患者125例,女性占51.20%,平均年龄为(66.7±12.3)岁,≥65岁的患者占64.80%,<45岁者仅占5.60%。腺瘤性息肉多分布在胃体和胃窦,分别占40.80%和32.80%,以单发(90.40%)、无蒂(76.81%)为主。65.94%的腺瘤性息肉直径≤1.0 cm。23.20%(29/125)的患者合并增生性息肉和/或胃底腺息肉,其中,合并多发息肉者占58.62%(17/29),1.60%(2/125)的患者同时存在两种病理类型的息肉,1.60%(2/125)的患者伴发G1期的胃神经内分泌肿瘤。13.60%(17/125)的腺瘤性息肉患者伴发胃癌,以进展期(70.59%)、未分化型(66.67%)癌为主。伴发低级别上皮内瘤变者为18.40%(23/125)。52.80%的背景胃黏膜是慢性萎缩性胃炎伴肠化生,自身免疫性胃炎占11.20%。幽门螺杆菌的阳性率为21.60%。胃腺瘤性息肉的癌变率为20.80%(26/125),癌变以分化型为主,但有的癌变为印戒细胞癌。直径>1.0 cm(OR=5.092,95%CI: 1.447~17.923,P=0.011)、表面形态不平伴有糜烂(OR=13.749,95%CI: 1.072~176.339,P=0.044)是癌变的独立危险因素。结论:胃腺瘤性息肉伴发胃癌的比例高、癌变率高,直径和表面形态是癌变的独立危险因素。内镜检查时应重视内镜下息肉病理类型的鉴别,并重视全胃黏膜的评估。

关键词: 腺瘤性息肉, 肿瘤, 多原发性, 内镜检查, 胃肠道, 危险因素

Abstract:

Objective: To investigate the endoscopic and pathological characteristics of gastric adenomatous polyps and to assess the potential risk factors for canceration of gastric adenomatous polyps. Methods: The endoscopic and pathological characteristics of the patients with gastric adenomatous polyps from January 1, 2005 to December 31, 2019 were summarized retrospectively, and the risk factors of canceration were analyzed. Results: A total of 125 patients with gastric adenomatous polyps were included, 51.20% of whom were females. The average age was (66.7±12.3) years. 64.80% of patients with gastric adenomatous polyps equal or more than 65 years old, and only 5.60% of the patients less than 45 years old. Adenomatous polyps were mostly distributed in the corpus and antrum with 40.80% and 32.80%, respectively. The majority of them were single (90.40%) and sessile (76.81%). 65.4% of adenomatous polyps were no more than 1.0 cm in diameter, and 23.20% of patients with adenomatous polyps were combined with hyperplastic polyps and/or fundus glandular polyps, and 1.60% had both pathological types of polyps. 58.62% (17/29) patients with hyperplastic polyps and/or fundus glandular polyps had multiple polyps. 1.60% (2/125) of the patients had gastric neuroendocrine tumor of G1 stage. Synchronous gastric cancer was detected in 13.60% (17/125) of the patients with adenomatous polyps, and the proportion of low-grade intraepithelial neoplasia was 18.40% (23/125). The main types of synchronous gastric cancer were progressive (70.59%) and undifferentiated (66.67%). Chronic atrophic gastritis with intestinal metaplasia was found in 52.80% of the patients, and autoimmune gastritis accounted for 11.20%. The positive rate of Helicobacter pylori was 21.60%. The canceration rate of gastric adenomatous polyps was 20.80%. The cancer was mainly differentiated, but there was sigmoid ring cell carcinoma as well. Diameter of >1.0 cm (OR=5.092, 95%CI: 1.447-17.923, P=0.011), uneven surface morphology and erosion (OR=13.749, 95%CI: 1.072-176.339, P=0.044) were independent risk factors of adenomatous polyps. Conclusion: The synchronous gastric cancer is common and the canceration of gastric adenomatous polyps is high with diameter and surface morphology as independent risk factors. We should pay attention to the identification of the pathological types of polyps and the evaluation of the whole gastric mucosa during the endoscopic examination.

Key words: Adenomatous polyps, Neoplasms, multiple primary, Endoscopy, gastrointestinal, Risk factors

中图分类号:

R735.2

牛占岳,薛艳,张静,张贺军,丁士刚. 胃腺瘤性息肉的内镜和病理特点及癌变的危险因素分析[J]. 北京大学学报（医学版）, 2021, 53(6): 1122-1127.

NIU Zhan-yue,XUE Yan,ZHANG Jing,ZHANG He-jun,DING Shi-gang. Analysis of endoscopic and pathological features of gastric adenomatous polyps and risk factors for canceration[J]. Journal of Peking University (Health Sciences), 2021, 53(6): 1122-1127.

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参考文献 17

[1]	Carmack SW, Genta RM, Schuler CM, et al. The current spectrum of gastric polyps: A 1-year national study of over 120,000 patients[J]. Am J Gastroenterol, 2009, 104(6):1524-1532. doi: 10.1038/ajg.2009.139
[2]	Corral JE, Keihanian T, Diaz LI, et al. Management patterns of gastric polyps in the United States[J]. Frontline Gastroenterol, 2019, 10(1):16-23. doi: 10.1136/flgastro-2017-100941
[3]	Enestvedt BK, Chandrasekhara V, Ginsberg GG. Endoscopic ultrasonographic assessment of gastric polyps and endoscopic mucosal resection[J]. Curr Gastroenterol Rep, 2012, 14(6):497-503. doi: 10.1007/s11894-012-0292-2 pmid: 23001857
[4]	Velázquez-Dohorn ME, López-Durand CF, Gamboa-Domínguez A. Changing trends in gastric polyps[J]. Rev Invest Clin, 2018, 70(1):40-45. doi: 10.24875/RIC.17002430 pmid: 29513301
[5]	Castro R, Pimentel-Nunes P, Dinis-Ribeiro M. Evaluation and management of gastric epithelial polyps[J]. Best Pract Res Clin Gastroenterol, 2017, 31(4):381-387. doi: S1521-6918(17)30060-4 pmid: 28842047
[6]	Chen WC, Wallace MB. Endoscopic management of mucosal lesions in the gastrointestinal tract[J]. Expert Rev Gastroenterol Hepatol, 2016, 10(4):481-495. doi: 10.1586/17474124.2016.1122520
[7]	Banks M, Graham D, Jansen M, et al. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma[J]. Gut, 2019, 68(9):1545-1575.
[8]	Laxén F, Sipponen P, Iham?ki T. Gastric polyps: their morphological and endoscopical characteristics and relation to gastric carcinoma[J]. Acta Pathol Microbiol Immunol Scand A, 1982, 90(3):221-228. pmid: 7102316
[9]	Borch K, Skarsgard J, Franzen L, et al. Benign gastric polyps: Morphological and functional origin[J]. Dig Dis Sci, 2003, 48(7):1292-1297. doi: 10.1023/A:1024150924457
[10]	Zhao G, Xue M, Hu Y, et al. How commonly is the diagnosis of gastric low grade dysplasia upgraded following endoscopic resection? A meta-analysis[J]. PLoS One, 2015, 10(7):e0132699. doi: 10.1371/journal.pone.0132699
[11]	de Vries AC, van Grieken NC, Looman CW, et al. Gastric cancer risk in patients with premalignant gastric lesions: A nationwide cohort study in the Netherlands[J]. Gastroenterology, 2008, 134(4):945-952. doi: 10.1053/j.gastro.2008.01.071
[12]	Meining A, Riedl B, Stolte M. Features of gastritis predisposing to gastric adenoma and early gastric cancer[J]. J Clin Pathol, 2002, 55(10):770-773. pmid: 12354805
[13]	Zhang H, Jin Z, Cui R, et al. Autoimmune metaplastic atrophic gastritis in chinese: A study of 320 patients at a large tertiary medical center[J]. Scand J Gastroenterol, 2017, 52(2):150-156. doi: 10.1080/00365521.2016.1236397
[14]	Zhang H, Nie X, Song Z, et al. Hyperplastic polyps arising in autoimmune metaplastic atrophic gastritis patients: Is this a distinct clinicopathological entity[J]. Scand J Gastroenterol, 2018, 53(10/11):1186-1193. doi: 10.1080/00365521.2018.1514420
[15]	Suzuki S, Gotoda T, Suzuki H, et al. Morphologic and histologic changes in gastric adenomas after Helicobacter pylori eradication: A long-term prospective analysis[J]. Helicobacter, 2015, 20(6):431-437. doi: 10.1111/hel.12218 pmid: 25704290
[16]	Malfertheiner P, Megraud F, O’Morain CA, et al. Management of Helicobacter pylori infection: the Maastricht V/Florence Consensus Report[J]. Gut, 2017, 66(1):6-30. doi: 10.1136/gutjnl-2016-312288 pmid: 27707777
[17]	Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, et al. Endosco-pic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline[J]. Endoscopy, 2015, 47(9):829-854. doi: 10.1055/s-0034-1392882 pmid: 26317585

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Year	Gastroscopy, n	Gastric adenomatous polyp, n (%)
2005	4 389	3 (0.07)
2006	7 185	8 (0.11)
2007	8 511	10 (0.12)
2008	9 192	7 (0.08)
2009	11 116	6 (0.05)
2010	11 348	4 (0.04)
2011	12 179	7 (0.06)
2012	13 772	13 (0.09)
2013	14 890	9 (0.06)
2014	16 404	8 (0.05)
2015	16 007	4 (0.02)
2016	17 592	13 (0.07)
2017	17 641	6 (0.03)
2018	19 422	17 (0.09)
2019	19 153	10 (0.05)
Total	198 801	125 (0.06)

Gastroscopic features	n (%)
Location
Cardia	10 (8.00)
Fundus	10 (8.00)
Body	51 (40.80)
Incisura angularis	5 (4.00)
Antral	41 (32.80)
Multiple	8 (6.40)
Number
Single	113 (90.40)
Multiple (n≥2)	12 (9.60)
Diameter/cm
≤0.5	32 (23.19)
>0.5-1.0	59 (42.75)
>1.0-1.5	15 (10.87)
>1.5-2.0	15 (10.87)
>2.0-2.5	5 (3.62)
>2.5-3.0	3 (2.17)
>3.0	9 (6.52)
Yamada type
Ⅰ	73 (52.90)
Ⅱ	33 (23.91)
Ⅲ	20 (14.49)
Ⅳ	12 (8.70)

Disease	n (%)
Other types of polyp
Fundic gland polyp
Single	0 (0)
Multiple	3 (2.40)
Hyperplastic polyp
Single	12 (9.60)
Multiple	12 (9.60)
Both	2 (1.60)
Neuroendocrine tumor
G1	2 (1.60)
G2	0 (0)
G3	0 (0)
Low grade intraepithelial neoplasia	23 (18.40)
High grade intraepithelial neoplasia	3 (2.40)
Early cancer	2 (1.60)
Advanced gastric cancer
Differentiated	4 (3.20)
Undifferentiated	8 (6.40)

Pathological features	n (%)
Polyp
High grade intraepithelial neoplasia	10 (8.00)
Canceration	16 (12.80)
Background
Chronic superficial gastritis	24 (19.20)
Autoimmune gastritis	14 (11.20)
Chronic atrophic gastritis	21 (16.80)
Chronic atrophic gastritis with intestinal metaplasia	66 (52.80)
Helicobacter pylori	27 (21.60)

Risk factors	Canceration, n	Non-canceration, n	χ²	P value
Gender
Male	9	52	2.644	0.104
Female	17	47
Age
<45	0	7	6.353	0.174
45-54	2	13
55-64	3	19
65-74	14	30
≥75	7	30
Location
Cardia	3	7	8.789	0.118
Fundus	4	6
Body	7	44
Incisura angularis	1	4
Antral	7	34
Multiple	4	4
Number
Single	21	92	3.509	0.061
Multiple (n≥2)	5	7
Diameter/cm
≤1.0	7	74	28.868	<0.001
1.1-2.0	7	20
2.1-3.0	5	3
>3.0	7	2
Type
Pedicless	16	80	4.291	0.038
Pedicled	10	19
Color
Normal	11	57	2.138	0.343
Red	11	33
White	4	9
Surface
Smooth	7	65	20.538	0.001
Rough	8	18
Lobulated	5	8
Erosion	1	6
Rough and erosion	3	1
Lobulated and erosion	2	1
Background
Chronic superficial gastritis	2	22	4.303	0.231
Autoimmune gastritis	4	10
Chronic atrophic gastritis	3	18
Chronic atrophic gastritis with intestinal metaplasia	17	49
Helicobacter pylori
Positive	5	22	0.125	0.724
Negative	21	76