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Precancerous lesions increase risk for gastric cancer in low-risk population
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A population-based cohort study in Sweden demonstrated patients with gastric precancerous lesions at all stages of progression based on Correa’s cascade increased their risk for developing gastric cancer compared with the general population.
Researchers used linked Swedish national registers to identify 405,211 patients who underwent a gastroscopic stomach biopsy for non-malignant indications from 1979 through December 2011. They then aimed to calculate gastric cancer incidence among patients with gastric precancerous lesions based on Correa’s cascade (in order of progression: normal, minor mucosal changes, non-atrophic chronic gastritis, atrophic gastritis, intestinal metaplasia and dysplasia) compared with patients with normal mucosa and the matched general population.
After excluding the first 2 years of follow-up, 1,599 cases of gastric cancer occurred (1,388 non-cardia gastric cancer; 211 cardia gastric cancer) among the 288,167 patients remaining in the Correa’s cascade subcohort (mean age at entry, 55.7 ± 19.3 years; 44.5% men).
They found an estimated one in 256 patients with normal mucosa, one in 85 with gastritis, one in 50 with atrophic gastritis, one in 39 with intestinal metaplasia and one in 19 with dysplasia would develop gastric cancer within 20 years. They observed these increased incidences were consistent throughout the follow-up period, and gaps between cumulative incidence curves grew continuously. They also observed that “interestingly, if repeated biopsy showed a change — upward or (more noteworthy) downward in the Correa’s cascade — compared with the initial grouping, this seemed to have prognostic significance.”
“Our results in a low-risk Western patient population show that all stages of Correa’s cascade predict an incidence of gastric cancer above that of the general population,” the researchers concluded. “The quantified absolute risks, along with future studies on other risk stratification factors and cost-benefit analyses, should guide the development of surveillance policies.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
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