2025 年第 12 期 第 20 卷

胃黏膜癌前状态时间演变的回顾性队列研究

A retrospective cohort study on the temporal evolution of gastric mucosal precancerous conditions

作者：陈昳璠张贺军丁士刚张静

英文作者：Chen Yifan Zhang Hejun Ding Shigang Zhang Jing

单位：北京大学第三医院消化科，北京100191

英文单位：Department of Gastroenterology Peking University Third Hospital Beijing 100191 China

关键词：胃癌前状态；肠型早期胃癌；内镜监测；进展时间

英文关键词：Gastricprecancerousconditions;Intestinal-typeearlygastriccancer;Endoscopicsurveillance; Progressiontime

• 摘要：

• 目的 探究胃黏膜癌前状态演进的时间规律，优化肠型早期胃癌筛查的内镜随访策略。方法 本研究采用回顾性队列研究设计，初始纳入2005年1月至2024年12月于北京大学第三医院消化内镜中心接受胃镜检查并行病理活检的5 655例胃黏膜病变患者。筛选出在以下病理终点［中度异型增生(MOD)、重度异型增生与肠型早期胃癌(SD/EGC)］前存在典型癌前状态的患者659例（SD/EGC组186例，MOD组473例）。通过内镜及病理资料分析癌前状态演进的时间规律。结果 659例患者中病灶主要分布于胃中1/3(299例，45.4%)及下1/3(312例，47.3%)，胃小弯(391例，59.3%)为最常见横轴位置。背景黏膜中肠上皮化生(IM)检出率为66.0%(435/659)。慢性萎缩性胃炎(CAG)进展至MOD的中位时间为28(21,74)个月(20例)，至SD/EGC为45(19，128)个月(12例)。IM、轻度异型增生(MD)及MOD进展至SD/EGC的中位时间分别为39(17，66)个月(103例)、38(18，75)个月(97例)及27(12，40)个月(46例)。结论 本研究通过分析CAG→IM→MD→MOD→SD/EGC（箭头表示进展至）的级联演进序列证实：随病变级别升高，其进展至终点病变所需的时间大致呈逐渐缩短趋势。其中，MOD进展至SD/EGC的中位时间为27个月。结合现有指南建议，考虑对MOD患者采取至少6～12个月间隔的高清染色内镜随访策略，从而基于其病变演进的时间规律为肠型胃癌早期筛查与干预提供循证依据。

• Objective To explore the temporal regularity of the progression of gastric mucosal precancerous conditions and optimize the endoscopic follow-up strategy for intestinal-type early gastric cancer screening. Methods A retrospective cohort study design was adopted in this study. Initially, 5 655 patients with gastric mucosal lesions who underwent gastroscopy and pathological biopsy at the Digestive Endoscopy Center of Peking University Third Hospital from January 2005 to December 2024 were enrolled. A total of 659 patients with typical precancerous conditions before the following pathological endpoints ［moderate dysplasia (MOD), severe dysplasia and intestinal-type early gastric cancer (SD/EGC)］ were screened out, including 186 cases in the SD/EGC group and 473 cases in the MOD group. The temporal trajectory of the progression of precancerous conditions was analyzed based on endoscopic and pathological data. Results Among the 659 patients, the lesions were mainly distributed in the middle third of the stomach (299 cases, 45.4%) and lower third (312 cases, 47.3%), with the lesser curvature of the stomach (391 cases, 59.3%) being the most common horizontal location. The detection rate of intestinal metaplasia (IM) in the background mucosa was 66.0%(435/659). The median time for chronic atrophic gastritis (CAG) to progress to moderate dysplasia (MOD) was 28(21, 74) months (20 cases), and to severe dysplasia and intestinal-type early gastric cancer (SD/EGC) was 45(19, 128) months (12 cases). The median progression times from IM, mild dysplasia (MD), and MOD to SD/EGC were 39(17, 66) months (103 cases), 38(18, 75) months (97 cases), and 27(12, 40) months (46 cases), respectively. Conclusion By analyzing the cascade progression sequence of CAG→IM→MD→MOD→SD/EGC (arrows indicate progression to), this study confirmed that with the elevation of lesion grade, the time required for progression to the endpoint lesion generally shows a gradually shortening trend. Among them, the median time for MOD to progress to SD/EGC was 27 months. Combined with the recommendations of existing guidelines, it is considered that a high-definition chromoendoscopy follow-up strategy with an interval of at least 6-12 months should be adopted for MOD patients, thereby providing evidence-based basis for the early screening and intervention of intestinal-type gastric cancer based on the temporal trajectory of lesion progression.