早期胃癌高危背景黏膜评估方式的比较研究

Comparison of Different Evaluating Methods for High-Risk Background Mucosa of Early Gastric Cancer

摘要: 目的：本研究旨在比较木村–竹本分类、OLGA分期及OLGIM分期评估高危背景黏膜发生早期胃癌风险的诊断效能，验证不同评估方式对早期胃癌患者风险评估的应用价值。方法：回顾性纳入2022年8月至2023年8月在青岛大学附属医院内镜中心行胃镜检查并依据新悉尼分类规范化活检取材的患者，其中病理结果证实为早期胃癌组的患者有120例，按性别与年龄1:2匹配240例非胃癌组患者作为对照组。比较两组患者一般临床资料、不同评估方式的风险分层的差异性，绘制不同评估方式诊断早期胃癌的受试者工作特征曲线(ROC)，多因素logistic回归分析与早期胃癌相关的独立危险因素。结果：OLGIM分期和木村–竹本分类对早期胃癌诊断价值最高(AUC分别为0.785、0.784)。胃癌家族史、Hp现症感染、木村–竹本的中、重度萎缩、OLGIM分期的III~IV期为早期胃癌的独立危险因素，胃癌家族史、Hp现症感染、木村–竹本的中、重度萎缩联合检测预测早期胃癌风险的AUC (0.806)高于单独使用OLGIM分期及木村–竹本分类。结论：木村–竹本分类可代替OLGIM分期用于评估高危背景黏膜发生早期胃癌的风险，与胃癌家族史、Hp现症感染联合检测更有助于早期胃癌风险的评估。

Abstract: Objective: To compare the diagnostic efficiency of different evaluating methods for high-risk background mucosa of early gastric cancer: the Kimura-Takemoto endoscopic atrophy classification, OLGA stage and OLGIM stage and to identify the independent risk factors. Methods: This study included patients retrospectively in the Endoscopic center of Affiliated Hospital of Qingdao University from August 2022 to August 2023 with gastroscopy and sampled biopsies based on the New Sydney classification; 120 patients in the early gastric cancer group and 240 patients in the non-gastric cancer group were matched by sex and age 1:2. The differences of general clinical data, risk stratification of different assessment methods between the two groups were compared, receiver operating characteristic curves (ROC) of patients diagnosed with early gastric cancer by different evaluation methods were drawn, and independent risk factors for gastric cancer were determined by multi-factor logistic regression analysis. Results: OLGIM stage and Kimura-Takemoto classification had the highest diagnostic value for gastric cancer (AUC = 0.785 and 0.784, respectively). Multivariate logistic regression indicated that family history of gastric cancer, current Hp infection, moderate to severe atrophy of Kimura-Takemoto and OLGIM stage III~IV were independent risk factors for early gastric cancer. The AUC (0.806) of family history of gastric cancer, current Hp infection, and Kimura-Takemoto combined test for predicting the risk of early gastric cancer was higher than that of OLGIM staging alone and Kimura-Takemoto classification. Conclusion: Kimura-Takemoto classification can be used instead of OLGIM stage to assess the risk of early gastric cancer in high-risk background mucosa, and the combined detection of family history of gastric cancer and Hp infection is more helpful for the assessment of early gastric cancer risk.