| Objective:Gastric cancer is one of the most common malignant tumors in the world.According to statistics from the International Agency for Research on Cancer in 2012,the incidence of gastric cancer ranks fifth in malignant tumors and the third in mortality.The incidence of gastric cancer in China is 31.28/100,000 and the mortality rate is 22.04/10.10,000,each accounted for 42.6% and 45.0% of the world.Ningde District of Fujian Province is a low-incidence area for gastric cancer.In 2017,the incidence rate of gastric cancer in Ningde CDC was 12.75/100,000.In 2002-2004,the mortality rate of gastric cancer in Fu’an City of Ningde District was 4.78/100,000.In 1978,the World Health Organization defined chronic atrophic gastritis as a precancerous disease.In 1994,the World Health Organization listed H.pylori as a Class I carcinogen for gastric cancer.H.pylori infection causes inflammation and immune response,which leads to changes in gastric glandular atrophy,intestinal metaplasia,intraepithelial neoplasia,etc.,and finally develops into gastric cancer.Method:During the period from January 2017 to December 2018,5436 patients were admitted to the MingDong Hospital affiliated to Fujian Medical University,who for upper gastrointestinal symptoms such as upper abdominal pain,nausea,acid reflux and bloating.The results of endoscopy,pathology,and C13/C14 urea breath test were recorded.Consistent with chronic inflammatory activity,no obvious glandular atrophy,intestinal metaplasia,intraepithelial neoplasia diagnosed aschronic superficial gastritis(CSG);consistent with atypical glandular atrophy,with or without intestinal metaplasia,the pseudo-pyloric gland metaplasia was diagnosed as Chronic atrophic gastritis(CAG),which was diagnosed as gastric cancer in accordance with adenocarcinoma,signet ring cell carcinoma,and high-grade intraepithelial neoplasia.In this research,the composition ratios of CSG,CAG and gastric cancer,and H.pylori infection were analyzed separately.The gastric artery mucosal atrophy was performed by OLGA(Operative link for gastritis assessment),which was associated with gastric cancer risk.OLGIM(Operative link for gastritis intestinal metaplasia assessment,operable intestinal metaplasia assessment associated with gastric cancer risk)staging,assess the relationship between the two stages and gastric mucosal malignant lesions;compare CAG different degrees of atrophy,with or without intestinal metaplasia,intraepithelial neoplasia Relationship with H.pylori infection;relationship between different age groups,gender CAG and H.pylori infection.Result:1.A total of 5436 patients in this study,including 3615 cases of CSG(66.50%),1790 cases of CAG(32.93%),and 31 cases of gastric cancer(0.57%).The pathological manifestations in CAG were 908 cases(16.7%),1384 cases(25.46%),and 185 cases(3.40%).In CAG,there were 1107 cases(61.84%)older than 50 years old.The OLGA/OLGIM gastric cancer risk staging method was performed on 175 CAG patients undergoing biopsy in the New Sydney system.The OLGA stage was 163 cases(93.14%)in stage 0-II and 12 cases(6.86%)in stage III-IV.OLGIM stage was 161 cases(92.0%)in stage 0-II and 14 cases(8.0%)in stage III-IV.2.H.pylori infection rate: The total infection rate is 63.59%,including CSG 62.30%,CAG 66.98%,and gastric cancer 70.97%.Among patients with CAG,mild atrophy was 69.72%,moderate atrophy was 72.87%,severe atrophy was 66.67%;intestinal metaplasia was 69.08%,no intestinal metaplasia was 59.85%;intraepithelial neoplasia was 72.43%,and no intraepithelial neoplasia was 66.36%.CAG patients were divided into 4 groups according to age,60.28% in the 20-39 age group,69.30% in the 40-49 year old group,71.10% in the 50-59 year old group,and 72.74% in the 60-year-old group and above.Conclusion:1.In the low-incidence area of gastric cancer in Fujian Ningde population,the incidence of CAG is low,especially severe atrophy,severe intestinal metaplasia,and low proportion of intraepithelial neoplasia.This may be one of the reasons for the low incidence of gastric cancer in this area.2.OLGA and OLGIM staging system scores were found.OLGA and OLGIM staging were positively correlated with gastric mucosal lesions.The higher the stage,the higher the detection rate of gastric mucosal malignant transformation,which has certain clinical significance for gastric cancer risk assessment.3.The H.pylori infection rate of atrophy,intestinal metaplasia and intraepithelial neoplasia was higher than that of no lesions,but the total infection rate of H.pylori and H.pylori infection rate in CAG were similar to those in China.The low incidence of gastric cancer may be related to other factors,which needs further study. |
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