1-year surveillance endoscopy recommended for patients at high risk for gastric cancer
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Patients at high risk for gastric cancer should undergo 1-year surveillance endoscopy, regardless of whether they initially underwent intensive index endoscopic examination using white light and narrow-band imaging, according to a study.
“Early detection of gastric cancer allows patients to receive minimally invasive treatment, potentially leading to better quality of life,” Yoshinobu Yamamoto, MD, PhD, of the department of gastrointestinal oncology at Hyogo Cancer Center in Japan, and colleagues wrote in JAMA Network Open.
The case-control study analyzed data from 4,523 patients (mean age, 70.6 years; age range, 20-85 years; 78% men) in Japan who were part of a multicenter, prospective randomized clinical trial that compared white light imaging with second-generation, narrow-band imaging in detecting early gastric cancer. The clinical trial ran from Oct. 1, 2014, to Sept. 22, 2017, at 13 hospitals, and researchers analyzed data from Dec. 26, 2019, to April 21, 2021.
Eligible patients had a history of endoscopic resection for an esophageal cancer or gastric neoplasm, current esophageal cancer or gastric neoplasm, or a history of treating esophageal cancer with chemotherapy and/or radiotherapy.
Surveillance endoscopy was planned 9 to 15 months after index endoscopy, and biopsies were performed on any new lesions detected during surveillance.
Outcomes of interest included detection rate of new gastric cancer within 15 months after index endoscopy and identification of risk factors linked to new cancer detection.
According to results, 4,472 patients underwent index endoscopy and the rate of early gastric cancer detection was 3% (n = 133). Surveillance endoscopy was conducted in 4,146 (92.7%) of the index endoscopy patients, and the rate of new gastric cancer detected within 15 months was 2.6% (n = 107). Among the 3% of patients with early detection of gastric cancer, 82.7% (n = 110) received surveillance endoscopy within 15 months, resulting in 10.9% (n = 12) with newly detected gastric cancer.
The secondary analysis compared 107 patients with newly detected gastric cancer during surveillance endoscopy with 107 matched patients without newly detected gastric cancer. Researchers determined that independent risk factors associated with new gastric cancer detection were the presence of open-type atrophic gastritis (OR = 6; 95% CI, 2.25-16.01) and early gastric cancer detection by index endoscopy (OR = 4.67; 95% CI, 1.08-20.21).
“These results suggest that, to detect new gastric cancer at an early stage, 1-year surveillance after detection of early gastric cancer in patients with high risk is warranted,” the researchers wrote.
Perspective
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Matthew Kroh, MD, FACS, FASGE, FASMBS
Gastric cancer is an aggressive disease that has significant morbidity and mortality; its incidence varies worldwide. In Japan, where the study originated, and in much of Asia, there is a high disease burden.
This group reported on outcomes after previous diagnosis of gastric cancer using two different diagnostic modalities — white light and narrow-band imaging — in patients who are at high risk for gastric cancer.
The findings are important because they demonstrated that the rate of new gastric cancer development approximately 1 year after first examination was almost 3% in both groups. The authors reported that there wasn’t a statistically significant difference between the groups.
The implications are key. One-year surveillance is probably warranted in patients who have had previous gastric cancer — even after an intensive endoscopic examination — because the rate was relatively high for finding this cancer early. Additionally, they showed that the presence of open-type atrophic gastritis and early gastric cancer detection by index endoscopy were predictors of finding a new gastric cancer.
This affects our practices around the world because it demonstrates the importance of patient follow-up. In particular, endoscopic evaluation — especially in early stages — may allow for less invasive ways of removing cancers, which can potentially spare surgery and the morbidity of stomach removal.
Other considerations for the study: It comes from a center that has expertise in different modalities of gastric cancer detection and treatment in Japan. Therefore, the results may not be generalizable to different parts of the world. In addition, the rate and etiology of gastric cancer is also highly variable so the specifics of the study — albeit important — may variably be applied to different patient populations around the world.
This is an important study because it reminds us that when gastric cancer is detected early with an appropriate screening strategy, it can result in lives saved and disease detected at earlier stages.
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