| Objective This article aims to retrospectively and comparatively study on patients with stage Ia and initial diagnosis of stage ? patients with gastric cancer,and to summarize relevant factors affecting the initial diagnosis of stage ? gastric cancer patients who had lost the early diagnosis occasion,and provide ideas and method for further improving the diagnostic level of stage la gastric cancer.Methods This study used retrospective research methods.From September 2016 to December 2017,106 patients with new-onset gastric cancer diagnosed by gastroenterology,gastrointestinal surgery,oncology,physical examination center,gastroscopy,and pathology were included in 45 patients with stage la gastric cancer and 61 patients with stage ? gastric cancer.Then consulting the relevant literature for indicators of gastric cancer diagnosis influencing factors,enrolled in the form of detailed statistics for gender,age,past dyspepsia,grade of hospital attending,treatment status,gastroscopy and barium examination,family history,smoking,alcohol consumption,blood pressure,differentiation and location of gastric cancer,health literacy,education level,medical background,screening for early gastric cancer(combined detection of pepsinogen,gastrin,and Helicobacter pylori antibodies),magnifying and staining gastroscopy,and pathological observation of consecutive sections of suspicious lesions and other indicators were analyzed by univariate analysis.Statistically significant observations were included inmulti-variate logistic regression analysis and summarize relevant factors affecting the initial diagnosis of stage IV gastric cancer without early diagnosis.Results There were 46 males(75.4%)of males with stage ? gastric cancer,15(24.6%)females,and male:female = 3.07:1.There were 33 cases(73.3%)of men with stage la gastric cancer,12 cases(26.7%)of women,and male:female = 2.75:1.There was no significant difference in gender composition between stage ? and stage Ia gastric cancer patients(?2=0.059,P=0.808).There was no significant difference in the average age of onset between stage ? and stage la gastric cancer patients(t=0.601,P=0.549).The difference in age stratification between stage ? and stage Ia gastric cancer patients was not statistically significant(?2 =0.051,P=0.821),there was a significant difference in gastroscopy between stage ? and stage Ia gastric cancer patients(?2=12.201,P=0.000).There was a significant difference between stage IV and stage la gastric cancer patients in magnification and color gastroscopy(?2= 30.523,P=0.000),there was a significant difference in early screening between stage ? and stage Ia gastric cancer(?2=48.400,P=0.000),there was a significant difference in the pathological observation of consecutive sections of suspicious lesions between stage ? gastric cancer and stage Ia gastric cancer(?2=60.010,P=0.000),significant difference in stage ? and stage Ia gastric cancer patients in the site of gastric cancer(?2=20.529,P-0.000),there was a significant difference in the differentiation of gastric cancer between stage ? and stage Ia gastric cancer(x2=77.712,P=0.000).There was a significant difference between stage ? and stage Ia gastric cancer patients in the previous diagnosis and treatment(?2=:21.053,P=0.000),there was a significant difference between stage ? and stage Ia gastric cancer patients in the previous hospitals(?2=17.880,P=0.000),Ihere was a significant difference in the family history of gastric cancer between stage ? and stage la gastric cancer patients(?2=13.368,P=0.000),significant difference in alcohol consumption between stage IV and stage la gastric cancer patients(?2=30.613,P=0.000),there was a significant difference between stage ? and stage Ia gastric cancer in terms of health literacy(?2= 19.876,P=0.000),there was a significant difference in the degree of education between patients with stage ? and stage Ia with gastric cancer(?2 =26.605,P=0.000),there was a significant difference in the medical background between patients with stage ? and stage Ia with gastric cancer(?2=27.997,P=0.000).After logistic regression analysis,the results were as follows:gastroscopy barium meal examination status,previous diagnosis and treatment status,hospital level,health literacy,differentiation,medical background,gastric cancer site,early detection of serum combined detection,magnifying and staining gastroscopy,pathological observation of consecutive sections of suspicious lesions showed that OR values>1,P<0.05,which was statistically significant.It can be seen that they are related factors affecting the initial diagnosis of stage ? gastric cancer without early diagnosis.Conclusions(1)From the doctor's point of view,without early screening of "PQ HP antibody,G-17 serum,etc.",gastroscopy without enlargement and staining,and pathological observation of consecutive sections of suspicious lesions in some lower-level hospitals affect initial diagnosis of stage ? gastric cancer patients who had lost the early diagnosis occasion.(2)In this study,stage 4 gastric cancer is mostly poorly differentiated gastric cancer which is mostly located in the cardia and stomach and is different from the antrum of the predilection site,doctors may not pay sufficient attention to these sites in the previous examinations,resulting in some missed diagnosis,affecting the early diagnosis of stage IV gastric cancer;at the same time,these sites may have special biological characteristics and need to be further explored.(3)From the patient's point of view,the patient's health literacy is low,there is no good medical background and a lack of understanding of gastric cancer-related knowledge,and some dyspeptic symptoms have not been positively diagnosed and treated which are also relevant factors that initial diagnosis of stage IV gastric cancer patients who had lost the early diagnosis occasion.(4)To improve the early diagnosis rate of stage IV gastric cancer in this group,the age of early screening needs to be advanced,it is recommended that the age of gastric cancer screening be no higher than 40 years old. |
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