Surveillance of premalignant gastric lesions: a multicentre prospective cohort study from low incidence regions

医学 胃肠病学 内科学 癌症 入射(几何) 癌前病变 前瞻性队列研究 队列 队列研究 病理 光学 物理
作者
Wouter J. den Hollander,Ingrid L. Holster,Caroline M. den Hoed,Lisette G. Capelle,Tjon J. Tang,Marie-Paule Anten,Ingrid Prytz-Berset,Ellen M. Witteman,Frank ter Borg,G. den Hartog,Marco J. Bruno,Maikel P. Peppelenbosch,Wilco Lesterhuis,Michael Doukas,Ernst J. Kuipers,Manon C.W. Spaander
出处
期刊:Gut [BMJ]
卷期号:68 (4): 585-593 被引量:128
标识
DOI:10.1136/gutjnl-2017-314498
摘要

Objective International guidelines recommend endoscopic surveillance of premalignant gastric lesions. However, the diagnostic yield and preventive effect require further study. We therefore aimed to assess the incidence of neoplastic progression and to assess the ability of various tests to identify patients most at risk for progression. Design Patients from the Netherlands and Norway with a previous diagnosis of atrophic gastritis (AG), intestinal metaplasia (IM) or dysplasia were offered endoscopic surveillance. All histological specimens were assessed according to the updated Sydney classification and the operative link on gastric intestinal metaplasia (OLGIM) system. In addition, we measured serum pepsinogens (PG) and gastrin-17. Results 279 (mean age 57.9 years, SD 11.4, male/female 137/142) patients were included and underwent at least one surveillance endoscopy during follow-up. The mean follow-up time was 57 months (SD 36). Four subjects (1.4%) were diagnosed with high-grade adenoma/dysplasia or invasive neoplasia (ie, gastric cancer) during follow-up. Two of these patients were successfully treated with endoscopic submucosal dissection, while the other two underwent a total gastrectomy. Compared with patients with extended AG/IM (PGI/II≤3 and/or OGLIM stage III–IV), patients with limited AG/IM (PG I/II>3 and OLGIM stage 0–II) did not develop high-grade adenoma/dysplasia or invasive neoplasia during follow-up (p=0.02). Conclusion In a low gastric cancer incidence area, a surveillance programme can detect gastric cancer at an early curable stage with an overall risk of neoplastic progression of 0.3% per year. Use of serological markers in endoscopic surveillance programmes may improve risk stratification.
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