Background/Objectives: Since 2013, eradication therapy forHelicobacter pylorigastritis (Hp-ET) has been covered by the National Health Insurance of Japan. Recently, the risk of post-eradication gastric cancer (pE-GC) has increased. pE-GC includes cancers that develop immediately and several years afterHp-ET. Therefore, we aimed to clarify the endoscopic and histological characteristics of late types of pE-GCs. Method: One hundred patients with differentiated cancers detected afterHp-ET who underwent endoscopic submucosal dissection from 2015 to 2023 were compared. Patients were divided into two groups; the immediate group (n = 69), with cancer detected within 6 years, and the delayed group (n = 31), with cancer detected within >6 years afterHp-ET. The background mucosa and tumor mucosa were examined individually. The endoscopic findings were as follows: enlarged folds, map-like redness, intermediate zone irregularity, and the presence of a regular arrangement of collecting venules and a light blue crest (background); an irregular surface structure, an irregular vascular pattern, an irregular surface pattern, and a gastritis-like appearance (tumor). The histological findings were as follows: a low remnant rate of the fundic glands, intestinal metaplasia (IM), crypt enlargement, and neutrophil infiltration (background); mosaicism, the elongation of noncancer ducts, and an overlying non-neoplastic epithelium (tumor). Results: There was no significant difference regarding the background mucosa and tumor mucosa between the two groups. In the delayed group, the remnant rate of the fundic glands was 19.8 ± 15.6%, and IM was 87.1% (27/31). Further, 90.3% (28/31) of the patients exhibited persistent neutrophil infiltration. Conclusion: This study suggested that patients with a low remnant rate of the fundic gland and IM and persistent mucosal inflammation were at high risk for developing pE-GCs.
背景/目的：自2013年起，幽门螺杆菌胃炎根除治疗已被纳入日本国民健康保险覆盖范围。近年来，根除后胃癌的风险有所增加。根除后胃癌包括在幽门螺杆菌根除治疗后立即发生以及数年后发生的癌症。因此，本研究旨在阐明迟发型根除后胃癌的内镜及组织学特征。方法：对2015年至2023年间接受内镜黏膜下剥离术的100例幽门螺杆菌根除治疗后发现的胃分化型癌患者进行比较分析。将患者分为两组：即时组（n=69），即根除治疗后6年内发现癌症；延迟组（n=31），即根除治疗后超过6年发现癌症。分别对背景黏膜和肿瘤黏膜进行观察。内镜观察指标包括：背景黏膜的皱襞增粗、地图样发红、中间带不规则、规则排列的集合静脉可见性及淡蓝色嵴；肿瘤黏膜的不规则表面结构、不规则血管形态、不规则表面模式及胃炎样外观。组织学观察指标包括：背景黏膜的胃底腺残留率、肠上皮化生、腺管扩张及中性粒细胞浸润；肿瘤黏膜的镶嵌结构、非癌性腺管延长及表面覆盖的非肿瘤性上皮。结果：两组间在背景黏膜和肿瘤黏膜特征上均无显著差异。在延迟组中，胃底腺平均残留率为19.8±15.6%，肠上皮化生发生率为87.1%（27/31）。此外，90.3%（28/31）的患者存在持续性中性粒细胞浸润。结论：本研究提示，胃底腺残留率低、伴有肠上皮化生及持续性黏膜炎症的患者具有较高的根除后胃癌发生风险。
肿瘤(癌症)患者之家