Risk Factors Of Gastric Cancer Caused By Chronic Atrophic Gastritis

Objective:This study retrospectively investigated the incidence of gastric cancer in patients with chronic atrophic gastritis during long-term follow-up and assessed the risk factors for gastric cancer in patients with chronic atrophic gastritis.Methods:This study included 522 patients who underwent gastroscopy and pathological diagnosis of CAG and completed endoscopic follow-up of more than 5 years in the Affiliated Hospital of Qingdao University from 2006 to 2012.The patient’s clinical data,endoscopic features and pathological reports were collected,including age,gender,smoking history,drinking history,HP infection,lesion location,and degree of gastric mucosal lesions.Analyze and compare the relationship between age,gender,smoking,drinking,Hp infection,gastric mucosal lesions and gastric cancer.Each time the gastroscopy and pathological examination were performed by our senior physician and pathologist.Rapid urease test using Hp assay.Endoscopy and pathological diagnosis meet the diagnostic criteria of gastroscope and pathology in the "Chinese Consensus on Chronic Gastritis" of the Chinese Medical Association Digestive Diseases Committee in 2006 and the Consensus Opinions on Screening and Endoscopic Diagnosis of Early Gastric Cancer in China.The Cox proportional hazard regression model was used to analyze the risk factors of progression to gastric cancer in patients with chronic atrophic gastritis.The univariate analysis was statistically significant(P<0.05)included in multivariate analysis).P<0.05(both sides)was considered statistically different for all analyses.Results:(1)A total of 522 patients were included in the study.The patients were 34-75 years old,with an average age of 50.3±4.27 years old,≤55 years old,and>55 years old,respectively,221 cases and 301 cases.Among them,the number of male patients was 279(53.4%),and the number of female patients was 243(46.6%);Among them,236 patients with Helicobacter pylori infection,146 patients underwent Hp eradication therapy,156 patients had a history of smoking,and 200 patients had a history of drinking.The first gastroscopy and pathological diagnosis were 150 patients(28.7%)with chronic atrophic gastritis,293 patients(56.1%)with chronic atrophic gastritis and intestinal metaplasia(IM),There were 65 patients(12.5%)with CAG with mild hyperplasia(ATP)and 14 patients(2.7%)with CAG with ATP(medium-to-severe).(3)After a mean follow-up of 7.57 years ± 1.74 years,20 of 522 patients with chronic atrophic gastritis were diagnosed with gastric malignancies,with an incidence of 3.83%(20/522).There were 9 cases of poorly differentiated adenocarcinoma,7 cases of moderately differentiated adenocarcinoma,2 cases of well differentiated adenocarcinoma,1 case of neuroendocrine carcinoma,and 1 case of malignant lymphoma.(3)Multivariate regression analysis of COX regression model showed that Male(HR=2.45,95%Cl:1.70～3.34,P=0.01),age>55 years old(HR=2.15,95%Cl:2.00～3.26,P=0.01),drinking(HR=1.10,95%CI:1.00～2.30,P=0.03),CAG with IM(HR=4.89,95%CI:4.10～8.13,P=0.02),CAG with ATP(mild)(HR=5.93,95%Cl:4.87～12.94,P<0.01),CAG with ATP(medium-to-severe)(HR=19.14,95%Cl:16.51～29.85,P<0.01)were risk factors for GC in CAG.Conclusion:Male,age>55 years old,drinking,gastric mucosal lesions(IM,ATP)are risk factors for GC in CAG.The risk of gastric cancer in patients with CAG and ATP(medium-to-severe)was significantly higher than that in patients with CAG with ATP(mild)and CAG with IM.Therefore,for men,age>55 years,drinking,CAG patients with intestinal metaplasia or/and mild dysplasia,endoscopic and histopathological follow-up should be strengthened,accompanied by medium-to-severe dysplasia CAG patients are the most important risk factor,and early endoscopic treatment is required after diagnosis.