Risk Factors For Invasive Canceration Of High-grade Gastric Neoplasia Of The Stomach Diagnosed By Gastroscopic Biopsy

Objective:With the development of pathological diagnosis and endoscopy technology,Diagnosis of gastric high-grade intraepithelial neoplasia(HGIN)by gastroscopic first pathological biopsy is increasingly emerging in clinical practice.Intraepithelial neoplasia is a term used to describe a series of diseases in which cells or structures change.It indicates potential abnormal changes in molecular biology that can lead to the progression of intraepithelial neoplasia to invasive cancer.Gastric intraepithelial neoplasia refers to the abnormal changes in cell and structure of epithelial neoplasia,but this change does not break through the basement membrane of gastric mucosal epithelium,so there is no infiltrative change.The fourth edition of WHO Digestive System Tumor Classification published in 2010 gives the classification of gastric intraepithelial neoplasia diagnosed by gastric mucosal biopsy,and divides gastric intraepithelial neoplasia into low-grade intraepithelial neoplasia and high-grade intraepithelial neoplasia.At present,gastroscopic biopsy is still the main method to diagnose gastric lesions.In clinical work,many patients with high-grade gastric intraepithelial neoplasia have undergone gastroscopic biopsy for the first time.The overall pathological findings after operation indicate that invasive carcinogenesis has occurred,which makes surgeons confused in clinical treatment: if invasive carcinogenesis has been combined but radical resection of gastric cancer has not been performed,treatment is insufficient;if not combined with infiltration,radical resection of gastric cancer Radical surgery for gastric cancer due to sexual canceration is suspected of overtreatment.In this study,78 patients with high-grade intraepithelial neoplasia of the stomach first diagnosed by endoscopic biopsy were retrospectively analyzed,and the risk factors of high-grade intraepithelial neoplasia complicated with invasive canceration of the stomach by endoscopic biopsy were discussed.Methods:The clinical data of 78 patients admitted in the Department of Gastrointestinal Surgery of Tongling People's Hospital from January 2013 to January 2018 with initial diagnosis of HGIN made by gastroscopic biopsy.According to hisology of pathological specimen after surgical operation,they were divided into the cancerous group(67 cases)and the non cancerous group(11 cases),and their gender,age,body weight change,blood test results,imaging data,endoscopic characteristics were compared.SPSS20.0statistical software was used for statistical analysis.Chi-square test was used for each measurement data,two-sample t-test was used for counting data.Risk factors of P<0.1 in univariate analysis were included in the binary logistic regression equation.The impact of each possible risk factor on invasive carcinogenesis was analyzed and judged.P<0.05 showed that the difference was statistically significant.The OR value and 95% credibility were used for the results.Interval representation.Finally,the ROC curve of gastroscopic biopsy for gastric high-grade intraepithelial neoplasia was drawn and the area under the line was calculated to verify the sensitivity.Results: Univariate analysis is showed that there were significant differences in age(P=0.003),mucosal ulceration(P < 0.001),Degree of differentiation(P=0.01),T stage of gastric tumor(P=0.015)and tumor diameter(P < 0.001)? In the multivariate analysis,tumor diameter(OR =4.25,95%CI:1.03 ~ 17.47,P=0.045)and mucosal ulceration(OR =11.08,95%CI:1.01~121.94,P=0.049)were independent risk factors for invasive canceration of high-grade gastric neoplasia.There was no statistic difference in the age(P>0.05),degree of differentiation(P>0.05)and T stage of gastric tumor(P>0.05)between two groups.Conclusion:Univariate analysis showed that age,lesion with ulcer,differentiation degree,T stage of tumors under gastroscope and diameter of tumors were risk factors of invasive carcinogenesis in patients with gastric high-grade intraepithelial neoplasia diagnosed by gastroscope biopsy.Focal diameter and ulcer are independent risk factors for endoscopic biopsy in the diagnosis of gastric high-grade intraepithelial neoplasia with invasive carcinogenesis.For biopsy-proven HGIN gastric mucosa lesions,whose size is large or with superficial mucosal ulter,we need to alert to the possible invasive canceration,so as to avoid an under-treatment.Due to the limited sample size,further researches are still needed.