胃镜精查提高早期胃癌检出率的研究
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摘要
目的分析近5年我院早期胃癌检出率,总结提高早期胃癌检出率的措施。方法回顾性分析2014年1月至2018年9月我院胃癌患者资料,统计经手术或内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)后病理证实的早期胃癌例数,对胃镜活检病理为上皮内肿瘤的患者召回行胃镜检查,分析此举措能否提高早期胃癌检出率。结果我院2014年1月至2018年9月共完成胃镜检查77 658例次,共发现胃癌738例,胃癌发现率为0. 95%;其中355例胃癌患者在我院行外科手术或ESD,病理证实为早期胃癌者148例,早期胃癌占我院治疗胃癌数量的41. 69%。已随访外院治疗胃癌172例,其中病理证实为早期胃癌者22例;早期胃癌总例数为170例,总的早期胃癌检出率为23. 04%。2017年至2018年异常病理患者570例,电话随访后,257例召回完成胃镜精查,精查率为45. 09%,精查后发现早期胃癌67例;总早期胃癌的检出率为31. 48%; 2014年至2016年异常病理患者412例,86例召回完成胃镜精查,精查率为20. 87%,精查后发现早期胃癌33例,总早期胃癌检出率为16. 43%。2017年至2018年的早期胃癌检出率明显高于2014年至2016年(χ2=23. 24,P=0. 001)。不确定的上皮内肿瘤患者中有97例完成胃镜精查,发现早期胃癌7例,占7. 22%;低级别上皮内肿瘤患者中,有211例完成胃镜精查,发现早期胃癌61例,占28. 91%;高级别上皮内肿瘤患者中35例完成胃镜精查,确诊早期胃癌32例,占91. 43%。结论对活检病理检查为不确定的上皮内肿瘤及上皮内肿瘤者由专人负责电话随访召回,进行胃镜精查能明显提高早期胃癌的检出率,减少漏诊,是提高早期胃癌检出率的有效措施。
Objective To analyze the detection rate of early gastric cancer in our hospital in the past 5 years,and to summarize the measures to improve the detection rate of early gastric cancer. Methods The data of gastric cancer patients in our hospital from Jan. 2014 to Sep. 2018 were retrospectively analyzed. The number of early gastric cancer cases confirmed by pathology after surgery or endoscopic submucosal dissection( ESD) was counted. Telephone followup and magnifying gastroscopy for patients with intraepithelial neoplasia were analyzed whether this measure can improve the detection rate of early gastric cancer. Results From Jan. 2014 to Sep. 2018,a total of 77 658 cases of gastroscope were completed in our hospital. A total of 738 cases of gastric cancer were found,and the detection rate of gastric cancer was 0. 95%. Among them,355 cases of gastric cancer were operated in our hospital for surgery or ESD. Among them,148 cases were early gastric cancer. One hundred and seventy-two gastric cancer patients who were underwent surgery in other hospital had been followed-up,including 22 cases of early gastric cancer confirmed by pathology,170 patients with early gastric cancer,the total detection rate of early gastric cancer was 23. 04%. From 2017 to 2018,there were 570 patients with abnormal pathology. Two hundred and fifty-seven patients were recalled to do magnifying endoscopy. After the magnifying endoscopy,67 patients with early gastric cancer were found. From 2014 to 2016,there were 412 patients with abnormal pathology. Eighty-six patients were recalled to complete the magnifying endoscopy and 33 patients with early gastric cancer were found. The detection rate of early gastric cancer from 2017 to 2018 was significantly higher than that from 2014 to 2016( χ2= 23. 24,P = 0. 001). Among the patients with uncertain intraepithelial tumors,97 patients underwent gastroscopy,and 7 patients with early gastric cancer were found. Among the low-grade intraepithelial tumor patients,211 patients completed gastroscopy and 61 patients with early gastric cancer were found. Among the patients with high-grade intraepithelial neoplasia,35 patients underwent gastroscopy,and 32 patients were diagnosed early gastric cancer. Conclusion Patients with uncertain intraepithelial neoplasia and intraepithelial neoplasia are recalled for magnifying endoscopy,which significantly improve the detection rate of early gastric cancer and reduce missed diagnosis. It is an effective measure to improve the detection rate of early gastric cancer.
Objective To analyze the detection rate of early gastric cancer in our hospital in the past 5 years,and to summarize the measures to improve the detection rate of early gastric cancer. Methods The data of gastric cancer patients in our hospital from Jan. 2014 to Sep. 2018 were retrospectively analyzed. The number of early gastric cancer cases confirmed by pathology after surgery or endoscopic submucosal dissection( ESD) was counted. Telephone followup and magnifying gastroscopy for patients with intraepithelial neoplasia were analyzed whether this measure can improve the detection rate of early gastric cancer. Results From Jan. 2014 to Sep. 2018,a total of 77 658 cases of gastroscope were completed in our hospital. A total of 738 cases of gastric cancer were found,and the detection rate of gastric cancer was 0. 95%. Among them,355 cases of gastric cancer were operated in our hospital for surgery or ESD. Among them,148 cases were early gastric cancer. One hundred and seventy-two gastric cancer patients who were underwent surgery in other hospital had been followed-up,including 22 cases of early gastric cancer confirmed by pathology,170 patients with early gastric cancer,the total detection rate of early gastric cancer was 23. 04%. From 2017 to 2018,there were 570 patients with abnormal pathology. Two hundred and fifty-seven patients were recalled to do magnifying endoscopy. After the magnifying endoscopy,67 patients with early gastric cancer were found. From 2014 to 2016,there were 412 patients with abnormal pathology. Eighty-six patients were recalled to complete the magnifying endoscopy and 33 patients with early gastric cancer were found. The detection rate of early gastric cancer from 2017 to 2018 was significantly higher than that from 2014 to 2016( χ2= 23. 24,P = 0. 001). Among the patients with uncertain intraepithelial tumors,97 patients underwent gastroscopy,and 7 patients with early gastric cancer were found. Among the low-grade intraepithelial tumor patients,211 patients completed gastroscopy and 61 patients with early gastric cancer were found. Among the patients with high-grade intraepithelial neoplasia,35 patients underwent gastroscopy,and 32 patients were diagnosed early gastric cancer. Conclusion Patients with uncertain intraepithelial neoplasia and intraepithelial neoplasia are recalled for magnifying endoscopy,which significantly improve the detection rate of early gastric cancer and reduce missed diagnosis. It is an effective measure to improve the detection rate of early gastric cancer.
引文
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[6] CHO J H,CHA S W,KIM H G,et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer:a comparison study to surgery using propensity score-matched analysis[J]. Surg Endosc,2016,30(9):3762-3773. DOI:10. 1007/s00464-015-4672-1.
[7] JUN J K,CHOI K S,LEE H Y,et al. Effectiveness of the Korean national cancer screening program in reducing gastric cancer mortality[J].Gastroenterology,2017,152(6):1319-1328. DOI:10. 1053/j. gastro. 2017. 01. 029.
[8] SUGANO K. Screening of gastric cancer in Asia[J]. Best Pract Res Clin Gastroenterol,2015,29(6):895-905. DOI:10. 1016/j. bpg.2015. 09. 013.
[9]杜奕奇,蔡全才,廖专,等.中国早期胃癌筛查流程专家共识意见(草案)(2017年,上海)[J].胃肠病学,2018,(2):8-14. DOI:10. 3969/j. issn. 1008-7125. 2018. 02. 007.
[2] CHEN W,ZHENG R,BAADE P D,et al. Cancer Statistics in China,2015[J]. CA A Cancer J Clin,2016,66(2):115-132. DOI:10.3322/caac. 21338.
[3] KATAI H,ISHIKAWA T,AKAZAWA K,et al. Five-year survival analysis of surgically resected gastric cancer cases in Japan:a retrospective analysis of more than 100,000 patients from the nationwide registry of the Japanese Gastric Cancer Association(2001-2007)[J].Gastric Cancer,2018,21(1):144-154. DOI:10. 1007/s10120-017-0716-7.
[4]中华医学会病理分会消化病理学组筹备组.慢性胃炎及上皮性肿瘤胃黏膜活检病理诊断共识[J].中华病理学杂志,2017,46(5):289-293. DOI:10. 3760/cma. j. issn. 0529-5807. 2017. 05. 001.
[5] RAFTOPOULOS S C,KUMARASINGHE P,DE BOER B,et al.Gastric intraepithelial neoplasia in a Western population[J]. Eur J Gastroenterol Hepatol, 2012, 24(1):48-54. DOI:10. 1097/MEG. 0b013e32834dc1bb.
[6] CHO J H,CHA S W,KIM H G,et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer:a comparison study to surgery using propensity score-matched analysis[J]. Surg Endosc,2016,30(9):3762-3773. DOI:10. 1007/s00464-015-4672-1.
[7] JUN J K,CHOI K S,LEE H Y,et al. Effectiveness of the Korean national cancer screening program in reducing gastric cancer mortality[J].Gastroenterology,2017,152(6):1319-1328. DOI:10. 1053/j. gastro. 2017. 01. 029.
[8] SUGANO K. Screening of gastric cancer in Asia[J]. Best Pract Res Clin Gastroenterol,2015,29(6):895-905. DOI:10. 1016/j. bpg.2015. 09. 013.
[9]杜奕奇,蔡全才,廖专,等.中国早期胃癌筛查流程专家共识意见(草案)(2017年,上海)[J].胃肠病学,2018,(2):8-14. DOI:10. 3969/j. issn. 1008-7125. 2018. 02. 007.