Background and Aims

Gastric cancer (GC) is a newly described cancer risk in Western patients with familial adenomatous polyposis (FAP). Little is known about clinical, endoscopic, and pathologic features associated with FAP-related GC. We compared these features in FAP patients with and without GC.

Methods

FAP patients were identified through the David G. Jagelman Inherited Colorectal Cancer Registries Cologene database. FAP patients with GC and randomly selected FAP patients without GC who had undergone at least 2 EGDs were analyzed. Demographic, clinical, endoscopic, and pathologic features were compared.

Results

Ten FAP patients with GC were identified, and 40 age-matched FAP control subjects were selected. No demographic differences were noted between patients and control subjects. All GC cases arose in the proximal stomach among gastric polyposis, with only 2 endoscopically visible. The prevalence of gastric polyposis was similar (100% vs 93%). Endoscopic features associated with GC included a carpeting of gastric polyps (100% vs 22.5%), solitary polyps >20 mm (100% vs 0%), and a polypoid mound of polyps (80% vs 0%; all P < .001). GC patients had a higher prevalence of gastric adenomas (30% vs 5%, P = .048) and polyps with high-grade dysplasia, including fundic gland polyps (50% vs 10%, P = .01) and pyloric gland adenomas (20% vs 0%, P = .037).

Conclusions

We identified endoscopic features and advanced pathology present in the stomachs of Western patients with FAP who developed GC. Upper GI surveillance in FAP should include the stomach and awareness of features associated with GC. Optimal approaches to treatment of gastric polyposis and methods of identification of early GC precursors in FAP are needed.

中文翻译：

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家族性腺瘤性息肉病与胃癌相关的内镜和组织学特征

背景和目标

胃癌（GC）是西方家族性腺瘤性息肉病（FAP）患者的一种新近描述的癌症风险。关于与FAP相关的GC相关的临床，内镜和病理学特征知之甚少。我们比较了有和没有GC的FAP患者的这些特征。

方法

FAP患者是通过David G. Jagelman遗传的结肠直肠癌注册科隆数据库进行鉴定的。分析了患有GC的FAP患者和随机选择了至少经历过2次EGD的无GC的FAP患者。比较了人口统计学，临床，内镜和病理特征。

结果

确定了10例FAP的GC患者，并选择了40名年龄相匹配的FAP对照受试者。患者和对照对象之间未发现人口统计学差异。在胃息肉病中，所有胃癌病例均发生在胃近端，只有2例在胃镜下可见。胃息肉的患病率相似（100％比93％）。与GC相关的内窥镜检查特征包括胃息肉（100％vs 22.5％），孤立性息肉> 20 mm（100％vs 0％）和息肉状息肉状丘（80％vs 0％;所有P  <.001 ）。胃癌患者胃腺瘤（30％vs 5％，P  = .048）和高度不典型增生的息肉的患病率较高，包括胃底腺息肉（50％vs 10％，P  = .01）和幽门腺腺瘤（ 20％和0％，P = .037）。

结论

我们确定了出现GC的西方FAP患者胃部的内镜特征和高级病理。FAP的上消化道监测应包括胃部和与GC相关的特征的意识。需要治疗胃息肉的最佳方法以及在FAP中鉴定早期GC前体的方法。