Analysis Of Clinicopathological Features And Risk Factors In Gastric Intraepithelial Neoplasia

Objective: To investigate the clinicopathological,endoscopic and epidemiological features of gastric intraepithelial neoplasia(GIN).To compare the pathological differences between biopsy confirmed gastric intraepithelial neoplasia and its diagnosis after endoscopic resection.To analyse the risk factors of gastric intraepithelial neoplasia and compare the difference between proximal gastric intraepithelial neoplasia(PGIN)and distal gastric intraepithelial neoplasia(DGIN).Methods: Guided with the WHO criteria,we investigated gastric endoscopic resections performed in the Nanjing Drum Tower hospital,and identified 485 gastric intraepithelial neoplasia between 2007 and 2014.Among them,156 were proximal gastric intraepithelial neoplasia and 329 were distal gastric intraepithelial neoplasia.All cases were followed up.The risk factors for pathological upgrading after EMR/MSD were studied through multiple factor analysis.Immunohistochemical method was applied to detect the expression of Ki-67,p53 and p504 s in normal gastric mucosa,intestinal metaplasia and atrophy,gastric low-grade intraepithelial neoplasia,gastric how-grade intraepithelial neoplasia and early gastric carcinoma.Risk factors of pathogenesis were identified by Logistic regression analysis.Results: Proportion of proximal gastric intraepithelial neoplasia in all GIN patients was significantly increased in recent years(p<0.05).Patients with PGIN were significantly elder than those with DGIN.The proportions of above 60 years old and how-grade intraepithelial neoplasia was higher in PGIN.There were no statistical differences between PGIN and DGIN groups in intestinal metaplasia,atrophy and Hp infection.Multi-factor analysis showed that reddish surface,the size more than 2cm in diameter,mucosal ulceration and proximal gastric lesion were independent factors for pathological upgrading after endoscopic resection.Immunohistochemical results showed that the rates of positive expression of Ki-67,p53 and p504 s in intestinal metaplasia and atrophy,gastric low-grade intraepithelial neoplasia,gastric how-gradeintraepithelial neoplasia and early gastric carcinoma were obviously increased.Compared to the normal gastric mucosa group,there were significant differences respectively(p<0.05).Advanced age,family cancer history,Helicobacter-pylori infection,less fruit intake and intestinal metaplasia and atrophy were independent risk factors for PGIN.In contrast,family cancer history,High sodium intake,Helicobacter-pylori infection,less fruit intake,intestinal metaplasia and atrophy were independent risk factors for DGIN.Conclusions: The incidence of proximal gastric intraepithelial neoplasia was on the rise,and the proportion of pathological upgrading after endoscopic resection was higher.There were no significant differences in the characteristics of adjacent mucosa and Helicobacter pylori infection between PGIN and DGIN.The expression of Ki-67,p53 and p504 s were involved in the occurrence and development of gastric cancer.We suggested they can help determine the severity and the development trend of disease.The risk factors of proximal gastric intraepithelial neoplasia were more similar to those of distal gastric intraepithelial neoplasia,and different from those of esophageal adenocarcinoma and Barrett's esophagus.