최신연구결과(해외)

NeoplasmImpact of Autoimmune Gastritis on Occurrence of Metachronous Gastric Neoplasms after Endoscopic Resection for Gastric Neoplasms

관리자
2023-10-30
조회수 127

Cancers (Basel). 2023 Oct 5;15(19):4859. doi: 10.3390/cancers15194859. 

국내에서 발표된 연구논문 이지만, 정리 차원에서 해외 연구결과 사이트에 올리게 되었습니다. 


AIG 관련하여 국내에서는 처음으로 원저가 나왔습니다. 과거 neoplastic lesion으로 resection을 받은 환자에서 metachronous gastric neoplasms의 발생에 있어 AIG 환자에서 3.3배 높은 위험도를 보인다는 연구입니다. 

이번 연구에서 AIG 환자는 혈청검사 중 APCA 양성 환자를 AIG 환자군으로 설정 했습니다. Extremly advanced AIG 환자에서는 APCA가 음성으로 전환 될 수도 있으므로, 일부 환자가 배제 되었을 수도 있겠지만 AIG 환자에서 metachronous neoplasms 발생 위험도가 높고, 누적 위험도의 상승은 이 질환의 진단과 앞으로 추적관찰에 대해 매우 의미있는 결과로 볼 수 있겠습니다. 


Simple Summary: Autoimmune gastritis (AIG), characterized by antibody production against gastric parietal cells, is associated with a higher incidence of neuroendocrine tumors and gastric cancers. Metachronous gastric neoplasms become a major concern after endoscopic resection (ER) for early gastric cancer lesions. We assessed the impact of AIG on MGN following ER. The AIG group had higher MGN rates (45.0% vs. 18.3%), with similar patterns of metachronous tumors. Multivariate analysis revealed AIG (HR 3.32) was linked to MGN occurrence. Because AIG patients face a greater MGN risk post-ER, positive anti-parietal cell antibody test results necessitate vigilant monitoring and management for timely treatment.


* Retrospective analysis

* Patients who underwent ER for gastric neoplasia at Seoul St. Mary’s Hospital in Seoul, Korea, between January 2015 and December 2017 (medical records of these patients until December 2022)

* AIG: positive for APCA, 

* H. pylori infection (one of the following positive results): rapid urease test (CLO test), polymerase chain reaction (PCR) test, histological examination (Warthin-Starry silver staining), gastric ER 시점에서의 serum H. pylori antibody 

* H. pylori state: H. pylori negative (HPN), H. pylori eradicated (HPE), H. pylori persistent (HPP), H. pylori status unknown (HPU)

Figure 1. Study flowchart. FAP: familial adenomatous polyposis. 


<Results>

3.1. Baseline Characteristics

* AIG group exhibited a significantly higher incidence of MGN than the non-AIG group (45.0% vs. 18.3%, p = 0.010).

Table 1. Basal characteristics of the patients. 


3.2. Metachronous Tumor Occurrence Patterns in Both Groups

* Although the occurrence rate of metachronous lesions differed significantly between the non-AIG and AIG groups, the occurrence patterns were similar (Table 2).  

Table 2. Comparison of the metachronous tumor occurrence patterns between the AIG and non-AIG groups.


* Three cases of endoscopic images of the antrum, angularis, corpus, initial lesion, and MGN lesions occurring in AIG patients are shown in Figure 2.

Figure 2. Endoscopic images of a patient with autoimmune gastritis (AIG) with the initial presence of resected gastric neoplasms and metachronous gastric neoplasms: (a) Case 1: 52-year-old male. Initial lesion was adenoma. Metachronous lesion with adenoma was observed after 30 months from the initial endoscopic resection; (b) Case 2: 71-year-old female. Initial lesion was tubular adenocarcinoma, well-differentiated. Metachronous lesion with adenoma was observed after 41 months from the initial endoscopic resection (c) Case 3: 82-year-old male. Initial lesion was tubular adenocarcinoma, well-differentiated. Metachronous lesion with adenoma was observed after 26 months from the initial endoscopic resection. (i) Endoscopic image of antrum; (ii) Angularis; (iii) Corpus; (iv) Initial lesion; (v); Metachronous tumor lesion.


* AIG group exhibited a higher incidence of metachronous occurrence than those in the non-AIG group (p = 0.001) (Figure 3).

Figure 3. Comparison of the risk of MGN occurrence after endoscopic resection for gastric neoplasm between the AIG and Non-AIG group. AIG, autoimmune gastritis. 


Table 3. Univariate and multivariate analyses of the MGN occurrence.


3.3. Subgroup Analysis Based on the Initial Pathology

* Occurrence rates were higher in patients with AIG (p = 0.036 for adenoma and p = 0.010 for carcinoma) (Figure 4).

Figure 4. Subgroup analysis of the risk of MGN occurrence in two different pathologies at the initial endoscopic resection. MGN, metachronous gastric neoplasms; AIG, autoimmune gastritis.


Conclusions 

Patients with AIG are at an increased risk of developing MGN following ER. The positive results of APCA testing independently hold clinical significance for predicting MGN. Given these findings, a more vigilant follow-up strategy is warranted for AIG patients after ER for gastric neoplasms.

 

Abstract: Gastric cancer is the fifth most common cancer and the third leading cause of cancer-related deaths worldwide. Autoimmune gastritis (AIG) is characterized by antibody production against the gastric parietal cells, reducing the number of functional parietal cells. It is also associated with an increased susceptibility to gastric neuroendocrine tumors and gastric cancer. Endoscopic resection (ER) is an effective treatment for early gastric cancer; however, metachronous gastric neoplasms (MGN) can develop. This study aimed to evaluate the clinical effect of AIG on the occurrence of MGN after ER for gastric neoplasms. We retrospectively analyzed patients who underwent ER for gastric neoplasms. Patients with multiple lesions, recurrent lesions, or a history of partial gastrectomy were excluded. The presence of AIG was determined using anti-parietal cell antibody (APCA) testing. Follow-up endoscopy and metachronous tumor occurrence rates were compared between the AIG and non-AIG groups. Of the 569 patients, 282 underwent APCA testing and 20 (7.1%) were diagnosed with AIG. The incidence of MGN was significantly higher in the AIG group than in the non-AIG group (45.0% vs. 18.3%); however, the MGN occurrence pattern was similar between the two groups. Multivariate analysis revealed that AIG (HR 3.32, 95% CI 1.55–7.10, p = 0.002) and a higher body mass index (HR 1.16, 95% CI 1.06–1.27, p = 0.002) were independent factors significantly associated with the occurrence of MGN. Patients with AIG have a higher risk of metachronous lesion occurrence after ER for gastric neoplasms. Positive results of APCA testing have independent clinical implications for predicting MGN. Proper monitoring and management are essential for early detection and treatment of recurrent lesions in patients with AIG. 

Keywords: autoimmune gastritis; metachronous gastric neoplasms; endoscopic resection; gastric cancer; anti-parietal cell antibody

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대한자가면역성위염연구회

주소 : 경기도 용인시 기흥구 중부대로 579, 508-23호 (구갈동, 강남대프라자)

대표전화 : 070-8080-0453  이메일 : autogastritis@gmail.com 


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