Analysis of clinical and endoscopic characteristics and progress-related risk factors of gastric low-grade intraepithelial neoplasia / 中华消化杂志

ABSTRACT

Objective:To analyze the clinical and endoscopic characteristics of gastric low-grade intraepithelial neoplasia (LGIN), and to explore the risk factors related to the progression of LGIN.Methods:The clinical, endoscopic and pathological data of 411 patients with LGIN diagnosed by initial pathological biopsy in the Department of Gastroenterology, the First People′s Hospital of Yichang (the People′s Hospital of China Three Gorges University) from January 1, 2012 to December 30, 2020 were retrospectively analyzed, and were followed up every three to six months and endoscopy and pathological biopsy were performed. The clinical data of patients were collected, which included age, gender, lesion location, lesion size, lesion type, lesion color, lesion appearance, family history of gastric cancer, history of smoking and alcohol intake, history of pickled food, whether complicated with intestinal metaplasia or gastric atrophy and the degree, whether there was Helicobacter pylori infection. According to the results of last follow up, the differences in above factors between progressive and non-progressive patients, and the risk factors for the progression of LGIN were analyzed. Indenpendent sample t test, chi square test, and univariate and multivariate logistic regression were used for statistical analysis. Results:Among the 411 patients with LGIN, there were 261 males and 150 females, the ratio of male to female was 1.74 ∶1; the mean age was (57.5±10.3) years old (30 to 86 years old). The most common clinical symptoms were abdominal pain, abdominal discomfort and abdominal distension, which accounted for 30.7% (126/411), 25.8% (106/411) and 20.9% (86/411), respectively. The lesions of 245 cases (59.6%) located in gastric antrum; the maximum diameter of lesions of 344 cases (83.7%) was 0.5 to less than 2.0 cm; the lesion types of 232 cases (56.4%), 104 cases (25.3%) and 75 cases (18.2%) were prominent type, flat type and depressed type, respectively. The lesion color of 298 cases (72.5%) was red, and that of 113 cases (27.5%) was normal or white. One hundred and seventy-one cases (41.6%) had surface erosion and 61 cases (14.8%) had surface ulcer. Two hundred and seventy-two cases (66.2%) of LGIN were complicated with intestinal metaplasia, and the proportions of mild, moderate and severe intestinal metaplasia were 50.4% (137/272), 33.8% (92/272) and 15.8% (43/272), respectively; 196 cases (47.7%) of LGIN were with gastric atrophy, and the proportions of mild, moderate and severe degree of gastric atrophy were 58.2% (114/196), 29.1% (57/196) and 12.7% (25/196), respectively. Rapid urease test or 14C urea breath test were carried out in 368 cases (89.5%), the positive rate of Helicobacter pylori infection was 45.1% (166/368), and the proportion of male was higher than that of female (59.6%, 99/166 vs. 40.4%, 67/166), and the difference was statistically significant ( χ2=4.537, P<0.05). All 174 patients with LGIN were successfully followed up, and the LGIN lesion of 11.5% (20/174) patients was progressive. The results of univariate analysis indicated that there were statistically significant differences in the lesion location, lesion size, lesion type, lesion appearance, atrophy, family gastric cancer history, history of alcohol intake, and history of pickled food between the patients with progressive lesions (20 cases) and the patients with non-progressive lesions (154 cases) ( χ2=11.950, 22.370, 8.964, 8.552, 10.362, 7.139, 5.913 and 4.668, all P<0.05). The results of multivariate logistic regression analysis showed that lesions in gastric corpus, maximum diameter of the lesion ≥2.0 cm, depressed lesions, ulcer lesions, atrophy, family gastric cancer, history of alcohol intake, history of pickled foods were independent risk factors of the progression of LGIN (odds ratio=4.796, 5.457, 4.431, 3.521, 1.380, 21.405, 3.294 and 1.832, 95% confidence interval 2.028 to 6.431, 3.256 to 8.943, 1.356 to 6.410, 1.305 to 5.706, 1.013 to 2.805, 5.062 to 25.391, 2.012 to 5.826, 1.072 to 3.790, all P<0.05). Conclusions:The lesions located in gastric corpus, maximum diameter of the lesion ≥2.0 cm, depressed lesions, ulcer lesions, atrophy, family gastric cancer history, history of alcohol intake, history of pickled foods are independent risk factors of the progression of LGIN. When the patients with LGIN have these characteristics, endoscopic resection should be considered.