胃癌及胃高级别上皮内瘤变多灶现象的临床研究  

Clinical study of multifocal phenomenon for gastric cancer and gastric high-grade intraepithelial neoplasia

作　　者：尹启航 许梦情 王莉杰 孙珂 马苗苗[1] 岳汶 张丹丹[1] 陶林[3] 张文杰[1,3] Qihang Yin;Mengqing Xu;Liji Wang;Ke Sun;Miaomiao Ma;Wen Yue;Dandan Zhang;Lin Tao;WenJie Zhang(Department of Pathology,Shihezi University School of Medicine,Key Laboratories for Xinjiang Endemic and Ethnic Diseases,Shihezi 832000,China;Department of Gastroenterology and Hepatology,Suzhou City Hospital,Suzhou 234000,China;Department of Pathology,The First Affiliated Hospital,Shihezi University School of Medicine,Shihezi 832000,China)

机构地区：[1]石河子大学医学院病理系,地方与民族高发病教育部重点实验室,新疆维吾尔自治区石河子市832000 [2]安徽省宿州市市立医院消化内科 [3]石河子大学医学院第一附属医院病理科

出　　处：《中国肿瘤临床》2020年第14期711-716,共6页Chinese Journal of Clinical Oncology

基　　金：国家科技支撑计划项目(编号:2009BAI82B02);新疆生产建设兵团科技成果转化项目(编号:2018BA006)资助。

摘　　要：目的:探讨同时性多发性胃癌和(或)高级别上皮内瘤变的临床病理特点,分析病灶之间的关联性。方法:收集2007年11月至2017年12月间于石河子大学医学院第一附属医院接受内镜下黏膜剥脱术或外科手术的56例同时性多发性胃癌和(或)高级别上皮内瘤变患者的临床资料,分析其临床病理特点,根据多发性胃癌中对主、副病灶的定义,探究病灶间的关联性。结果:56例同时性多发性胃癌和(或)高级别上皮内瘤变患者平均年龄为(63.82±11.88)岁,男性多见,占75%(42/56),伴有病灶周围黏膜萎缩患者为25例(44.64%)。主、副病灶的浸润深度均以T1期为主。主、副病灶的直径呈正相关(r=0.797,P<0.001),病理类型具有关联性(P=0.007);内镜分型具有较高的一致性(P<0.001);在空间分布方面,主、副病灶也具有关联性,其中垂直位置列联相关系数c=0.484(P=0.002),水平位置列联相关系数c=0.535(P=0.007)。同时性多发性胃癌和(或)高级别上皮瘤变中主病灶在淋巴结转移、TNM分期、是否合并黏膜萎缩等方面与单发性胃癌或高级别上皮内瘤变存在差异。结论:同时性多发性胃癌和(或)高级别上皮内瘤变的高危人群为合并黏膜萎缩的老年男性,在胃镜检查时应注意根据主、副病灶间的关联性仔细观察,避免漏诊。Objective:To investigate the clinicopathological characteristics and relevance of main and minor lesions of synchronous multiple gastric cancer and gastric high-grade intraepithelial neoplasia.Methods:We retrospectively reviewed 56 patients with synchronous multiple gastric cancer and gastric high-grade intraepithelial neoplasia who had been treated with operation and endoscopic submucosal dissection.Their clinicopathologic characteristics were summarized,and the correlation between main and minor lesions were analyzed.Results:Among the 56 patients,with a mean age of(63.82±11.88)years,75%were men whereas 25%were women.Twenty-five(44.64%)patients had mucosal atrophy.The depth of tumor invasion in main and minor lesions was mainly stage T1.The size of main and minor lesions showed a positive correlation(r=0.797,P<0.001).The pathologic type of main and minor lesions demonstrated a moderately significant positive correlation(P=0.007).The endoscopic classification between major and minor lesions had a statistically significant consistency(P<0.001).The comparison of location between main and minor lesions showed a correlation:the correlation coefficient of the vertical position was 0.484(P=0.002)and that of the horizontal position was 0.535(P=0.007).Main lesions in multifocal gastric cancer or high-grade gastric intraepithelial neoplasia differed from single-focal gastric cancer or high-grade gastric intraepithelial neoplasia in terms of lymphatic metastasis,the TNM stage,and mucosal atrophy.Conclusions:Old men who had lesions combined with mucosal atrophy were considered as the high-risk group among patients with synchronous multiple gastric cancer and gastric high-grade intraepithelial neoplasia.Therefore,clinicians must keep a high grade of suspicion and make careful observations during the endoscopic examination,considering the correlation between main and minor lesions,in order to avoid any misdiagnosis.

关 键 词：胃肿瘤 高级别上皮内瘤变 多灶 临床病理特点 

分 类 号：R735.2[医药卫生—肿瘤]