| Background and objectiveGastric cancer（GC）is one of the common cancers in my country and even the whole world.At present,GC is still the main killer worldwide.Many GC patients missed a better treatment opportunity because they were not discovered in time,and then lost their lives.The symptoms of patients with early gastric cancer（EGC）are mostly unobvious.Patients with symptoms such as abdominal pain,bloating,acid reflux,and hematemesis are mostly advanced gastric cancer,and the mortality rate is high.According to different sites of cancer,GC can be divided into gastric cardia cancer,the cancer of gastric fundus and subcardia area,gastric body cancer,gastric antrum cancer,etc.The cancer of gastric fundus and subcardia area,a special type of GC,refers to cancer which is located between the lower part of the cardia and the upper part of the stomach.In recent years,the cancer of gastric fundus and subcardia area is more common in our country,and its incidence is high.Because this type of GC has a special anatomical structure and location,it is more likely to be missed and misdiagnosed,and the fatality rate is higher than other types of gastric cancer.Therefore,early diagnosis is of great significance for improving the prognosis of the cancer of gastric fundus and subcardia area,guiding treatment and reducing the mortality rate.Serological indicators are non-invasive indicators for screening GC and precancerous lesions,which has the advantages of simple process,low price,and low risk.It is widely used in clinical physical examinations and screening diseases,and has gradually become an necessary indicator for hospitalized patients.In recent years,with the development of endoscopy technology becomes more and more mature,as well as medical staff awareness of the EGC further changes,the detection rate of the early cancer of gastric fundus and subcardia area has gradually increased.In endoscopy,as a better and more intuitive technical method,ME-NBI has been widely used in the diagnosis and treatment of GC and other gastrointestinal diseases[1].It can not only observe the surface conditions of GC or other gastric mucosal diseases more intuitively and clearly,but also make a more accurate diagnosis based on the opening of the gland and the direction of the blood vessel.It can not only observe the surface conditions of gastric cancer or other gastric mucosal diseases more intuitively and clearly,but also make a more accurate diagnosis based on the opening of the gland and the direction of the blood vessel.Compared with ordinary white light endoscopy,it is more accurate in the diagnosis of EGC（including the early cancer of gastric fundus and subcardia area）.At present,ME-NBI has been widely used in the clinical diagnosis of GC,which has higher specificity and sensitivity.Due to its special location and different distribution of secretory cells in the glands,the pathogenesis of cancer gastric fundus and subcardia area is different from other types of GC such as gastric antrum cancer and gastric body cancer,the expression levels of serological indicators may be different.The purpose of this study was to analyze the diagnostic value of serological non-invasive indexes and ME-NBI for cancer of the cancer of gastric fundus and subcardia area,and to conduct comparative evaluation at the same time.We explore better early detection methods for the cancer of gastric fundus and subcardia area,mainly to provide opportunities for early treatment of patients and reduce the mortality of GC patients.Materials and MethodsWe selected 181 patients who visited the Gastroenterology Department of the Second Affiliated Hospital of Zhengzhou University from January 2017 to November2020,and performed serological and ME-NBI examinations at the same time.Among them,96 patients had pathological diagnosis of the cancer of gastric fundus and subcardia area,57 cases of male patients,39 cases of female patients,aged under 70years old,with an average age of 51.92±11.2 years old.There were 85 patients in the non-cancerous group,including 50 males and 35 females,who were also under 70years old,with an average of 52.15±10.56 years old.We accurately analyzed the serological indicators of the two groups of subjects to obtain effective serological indicators.At the same time,we divided the patients with the cancer of gastric fundus and subcardia area into two groups（abdominal metastasis group and no abdominal metastasis group）to observe the effectiveness correlation between the index and its abdominal metastasis.All the pictures of ME-NBI were analyzed and evaluated by experienced physician to make an endoscopic diagnosis,and then combined with endoscopic and pathological classification to explore the value of ME-NBI in the diagnosis of the cancer of gastric fundus and subcardia area.Accuracy,95%confidence interval（CI）,specificity and sensitivity were used to analyze the value of the effective serological indicators and ME-NBI in the diagnosis of the cancer of gastric fundus and subcardia area,and these two different inspection methods were evaluated comparatively.Results1.Serological resultsThe preliminary analysis found that the serological indicators G-17,PGⅠ,PGR,CA724,CA125,CEA,Fer,and Hcy were significant in the diagnosis of the cancer of gastric fundus and subcardia area,while PGⅡhad no diagnostic significance for the cancer of gastric fundus and subcardia area.We performed binary Logistic regression analysis of meaningful indicators,and found that serum G-17,PGⅠ,CA125,and Fer were not significantly correlated with the diagnosis of the cancer of gastric fundus and subcardia area,while serum PGR,CA724,CEA,Hcy had significant correlation.We analyzed the effective indicators（PGR,CA724,CEA,Hcy）and draw ROC curves.When the threshold values of serum PGR,CA724,CEA,and Hcy were7.93,6.29,2.72,and 13.27,their sensitivities were 69.2%,61.3%,81.9%,and 68.8%,and their specificities were 60.0%,90.6%,78.8%,81.2%.The combination of CA724and CEA had the highest sensitivity（83.6%）,the combination of CA724 and Hcy had the highest specificity,which was 90.3%,and the combination of three indicators had the highest AUC of 0.891,and its sensitivity and specificity were 82.9%,91.6%.Comparing the levels of CA724,Hcy,and CEA in the cancer of gastric fundus and subcardia area with abdominal cavity metastasis and no abdominal cavity metastasis group,the difference between groups was statistically significant,but PGR was not statistically significant.CEA had a higher sensitivity of 85.6%,while CA724 had a higher specificity and the largest AUC value.2.ME-NBI resultsME-NBI had an accuracy of 0.95（95%CI 0.93-0.98）in diagnosing the cancer of gastric fundus and subcardia area and the sensitivity is 0.96,the specificity was0.94,the positive predictive value was 0.95,and the negative predictive value was0.95.The ME-NBI endoscopic diagnosis and pathological diagnosis had high consistency（Kappa≥0.75）,and there was no statistical difference in the diagnosis of the cancer of gastric fundus and subcardia area（P>0.05）.We compared the gastric mucosal microstructure between gastric fundus subcardia cancer and the control group and found that there were significant differences between the two.Gastric mucosal cancer was mainly manifested as borderline,irregular or missing duct microstructure,and irregular microvascular.In 96 patients with the cancer of gastric fundus and subcardia area,the most common site was the posterior wall of the minor curvature,accounting for 57.3%,and the incidence of the greater curvature was relatively rare.The most common pathological type was well-differentiated tubular adenocarcinoma,which accounted for 31.3%.We applied Fisher’s exact probability test in the analysis of endoscopic classification and histopathological type,the difference between the microscopic classification and pathological type of the cancer of gastric fundus and subcardia area was statistically significant（P<0.05）.3.The comparison results of ME-NBI and serological index in the diagnosis value of the cancer of gastric fundus and subcardia areaThe comparison of the diagnostic value of ME-NBI and each single index:compared with the diagnostic accuracy of ME-NBI,PGR,CA724,CEA,and Hcy,The differences between the groups were significant,and they were statistically significant（P<0.05）.Comparison of the diagnostic value of ME-NBI and the combined index:compared with the combined index of serology,the difference between ME-NBI and the combined index was statistically significant（P<0.05）.Compared with a single index,the combination of CA724,CEA,and Hcy had greater significance in the diagnosis of the cancer of gastric fundus and subcardia area,while ME-NBI performs better.Conclusions1.PGR,CA724,CEA,and Hcy have certain diagnostic value for the cancer of gastric fundus and subcardia area.2.The most common site for the cancer of gastric fundus and subcardia area is the posterior wall of the minor curvature.ME-NBI has high sensitivity,specificity and diagnostic accuracy.3.In the diagnosis of the cancer of gastric fundus and subcardia area,ME-NBI is overall better than serological indicators. |
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