Clinical features of gastritis cystica profunda and risk factors of its coexistence with gastric cancer
10.3760/cma.j.cn321463-20240517-00205
- VernacularTitle:深在性囊性胃炎的临床特点及合并胃癌的危险因素分析
- Author:
Jue WANG
1
;
Jiajia LIN
;
Chen GONG
;
Qi JIANG
;
Pinghong ZHOU
;
Jianwei HU
Author Information
1. 复旦大学附属中山医院内镜中心，上海 200032
- Keywords:
Gastritis;
Cardia;
Gastritis cystica profunda;
Gastric cancer;
Endoscopic treatment;
Curative resection
- From:
Chinese Journal of Digestive Endoscopy
2024;41(10):809-814
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical features of gastritis cystica profunda (GCP) and investigate the risk factors associated with its coexistence with gastric cancer.Methods:Data of 149 patients with pathologically confirmed GCP at Zhongshan Hospital of Fudan University between January 2015 and March 2022 were retrospectively analyzed for basic information, clinical data, lesion manifestations and pathological results, of which 106 were pathologically confirmed GCP after endoscopic resection and 43 others were pathologically confirmed GCP after surgical procedures. Among 149 patients, 56 were in the simple GCP group, and 93 in the GCP combined with gastric cancer group.Results:In the simple GCP group of 56 patients, 62.5% (35/56) were male and the mean age was 58.8 years. The predominant site of involvement was in the upper gastric segment (cardia and fundus) (51.8%,29/56), with manifestations primarily of the polypoid bulge type (41.1%,23/56) and submucosal bulge type (35.7%,20/56). Clinical symptoms were mostly atypical. In the group where GCP was combined with gastric cancer (93 cases), males accounted for 90.3% (84/93), the median age was 66.9 years, the upper gastric segment was predominantly affected (75.3%, 70/93), with differentiated cancer being the most common histological type (91.4%, 85/93). For 76 cases of early gastric cancer combined with GCP, mucosal lesions were the main presentation (73.7%, 56/76) with atypical clinical symptoms. Furthermore, in 17 cases of progressive gastric cancer combined with GCP, the manifestations were mainly bulging ulcers (88.2%, 15/17), and most of them were referred to the doctor because of abdominal pain and black stools (100.0%, 17/17). Binary logistic regression analysis showed that being male ( P=0.004, OR=4.411, 95% CI: 1.621-12.002), age ( P=0.001, OR=1.085, 95% CI: 1.036-1.136) and endoscopic manifestations of mucosal lesions ( P<0.001, OR=5.080, 95% CI: 2.162-11.939) were risk factors for GCP combined with gastric cancer, but involvement of the upper gastric segment was not related to combination with gastric cancer ( P=0.430, OR=0.707, 95% CI: 0.299-1.672). Among 106 patients with endoscopic resection, 57 cases of early gastric cancer combined with GCP had a median lesion length of 2.50 cm; 49 cases of GCP alone had a median lesion length of 1.20 cm, with significant difference ( Z=-5.503, P<0.001). All upper gastric GCP combined with early gastric cancer in endoscopically treated patients were cancers of the cardia, most of which were superficial elevation with the concave type (0-Ⅱa+Ⅱc) (44.7%, 21/47). 75.4% (43/57) patients with gastric cancer combined with GCP were graded as curative resection (eCuraA) after endoscopic surgery , and none of those who had additional surgery after endoscopic surgery had lymph node metastasis. There were 8 cases with history of gastric surgery, 7 of esophageal cancer, and 10 of multiple neoplastic gastric lesions in the 149 patients with GCP. Conclusion:GCP often occurs in the upper gastric region and is not inherently associated with the presence of gastric cancer. However, when coexisting with gastric cancer, it tends to affect elderly men, present with mucosal lesions of a differentiated histological type, and may be accompanied by esophageal or other gastric cancers. Notably, GCP is frequently identified as para-cancerous lesion, and endoscopic treatment emerges as a safe and effective approach, characterized by a high rate of curative endoscopic resections and a low incidence of lymphatic metastases.
