京都胃炎分类评分在胃镜下识别未分化型与分化型胃癌的价值

Identification of undifferentiated and differentiated gastric cancer under endoscope based on Kyoto classification score

摘要:

目的 探讨京都胃炎分类评分对未分化型和分化型胃癌的区分价值，并基于此，建立内镜下区分未分化型胃癌的预测评分系统。方法 回顾性分析该院第六医学中心确诊的183例胃癌患者的临床资料，根据病理分为分化组（95例）和未分化组（88例）。比较两组患者年龄、性别和京都胃炎分类评分等，通过二元Logistic回归分析筛选未分化型胃癌相关因素，并基于得到的比值比（OR＾），建立未分化型胃癌预测评分系统，绘制受试者操作特征曲线（ROC curve）。结果 与分化组比较，未分化组萎缩评分、肠上皮化生评分、弥漫性发红评分和京都胃炎分类评分总分较低（P < 0.01）。年龄 < 55岁（P < 0.05）、女性（P < 0.05）和胃黏膜C1萎缩或无萎缩（P < 0.01）与未分化型胃癌独立相关。建立的未分化型胃癌预测评分系统，区分未分化型胃癌的曲线下面积（AUC）为0.881（95%CI：0.828～0.934），最佳截断值的敏感度为80.70%，特异度为90.50%。结论 未分化型和分化型胃癌患者京都胃炎分类评分有差异，建立的未分化型胃癌预测评分系统，对区分未分化型胃癌有一定的价值。

Abstract:

Objective To explore the value of the Kyoto classification score in differentiating undifferentiated gastric cancer from differentiated gastric cancer, and establish a predictive scoring system for differentiating undifferentiated gastric cancer under endoscope.Methods 183 gastric cancer patients were retrospectively analyzed. According to pathology, 95 patients were included in the differentiated group and 88 were included in the undifferentiated group. The age, gender and Kyoto classification score of patients in the two groups were compared, and the factors associated with undifferentiated gastric cancer were screened by binary Logistic regression analysis. The predictive scoring system for undifferentiated gastric cancer was established based on the obtained odds ratio (OR＾) values, and the receiver operator characteristic curve (ROC curve) was drawn.Results Compared with differentiated group, the total scores of Kyoto classification, atrophy, intestinal metaplasia and diffuse redness were lower in undifferentiated group (P < 0.01). Under the age of 55 (P < 0.05), female (P < 0.05), and C1 atrophy or no atrophy (P < 0.01) were independently associated with undifferentiated gastric cancer. The area under the curve (AUC) of predictive scoring system for undifferentiated gastric cancer was 0.881 (95%CI: 0.828~0.934), and the sensitivity and specificity were 80.70% and 90.50% at the optimal cut-off value.Conclusion There are differences in Kyoto classification scores between undifferentiated and differentiated gastric cancer patients. The predictive scoring system of undifferentiated gastric cancer established by us has certain value in distinguishing undifferentiated gastric cancer under endoscope.