ABSTRACT
Objective:To explore the risk factors involved in gastritis, gastric intraepithelial neoplasia (GIN) and gastric cancer in Shihezi area.Methods:A total of 7 110 Han nationality patients who underwent gastroscopy at the First Affiliated Hospital of Shihezi University School of Medicine from January 2012 to December 2016 were selected as the research subjects. The data of patients were obtained through medical records and questionnaires. After excluding diseases related to esophagus and duodenum, a total of 4 429 cases were included in the retrospective analysis. Of which, 4 249 were gastritis, 93 were GIN, and 87 were gastric cancer. χ2 test, rank-sum test or Fisher exact probability method were used to analyze the differences of various factors in gastritis, GIN and gastric cancer. Univariate and multivariate logistic regression analysis were used to screen the risk factors for gastritis progression to GIN and gastric cancer. Results:χ2 test and rank sum test showed that there were statistically significant differences in gender, age, history of digestive diseases and distribution of Helicobacter pylori ( HP) infection among the groups of gastritis, GIN and gastric cancer ( P<0.05). The proportion of HP infection decreased gradually with the disease severity. Multivariate logistic regression analysis showed that male ( P<0.001, OR=2.251, 95% CI: 1.461-3.470), elderly ( P<0.001, OR=4.829, 95% CI: 2.241-10.409), a family history of gastric cancer ( P=0.002, OR=3.227, 95% CI: 1.537-6.774) and a history of digestive diseases ( P=0.034, OR=1.644, 95% CI: 1.037-2.607) were independent risk factors for gastritis progression to GIN. Male ( P<0.001, OR=3.254, 95% CI: 2.026-5.225), middle-aged ( P=0.022, OR=2.688, 95% CI: 1.153-6.265) and elderly ( P=0.002, OR=4.734, 95% CI: 1.750-12.807) were independent risk factors for gastritis progression to gastric cancer. In stratified analysis to exclude age and gender, smoking ( P=0.028, OR=4.060, 95% CI: 1.160-14.202) was found to be a risk factor for gastritis progression to GIN in young adults, and obesity ( P=0.032, OR=3.869, 95% CI: 1.121-13.356) was found to be a risk factor for gastritis progression to gastric cancer in women. Conclusion:The degree of HP infection in gastric tissues is negatively correlated with the severity of gastric diseases, suggesting that HP infection may be an early event inducing gastric cancer. Male, the elderly, people with a family history of gastric cancer and a history of digestive diseases, and young smokers in Shihezi are more likely to develop GIN, and male, middle-aged, elderly, and obese women are at increased risk of gastric cancer.
ABSTRACT
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.