Clinical–Alimentary TractGastric Cancer Risk in Patients With Premalignant Gastric Lesions: A Nationwide Cohort Study in the Netherlands
Section snippets
Histopathology Database
In the Netherlands, all histopathology and cytopathology reports are collected in a national archive (PALGA database), which has nationwide coverage since 1991.11 Each report can be tracked to an individual patient with a unique identifier, allowing follow-up on an individual basis regardless of whether treatment is received at the same or different institutes. Every record in the database contains a summary of the original pathology report and diagnostic codes similar to the Systematized
Results
A cohort of 92,250 patients with a first diagnosis of a premalignant gastric lesion was identified, with a 1:1 male-to-female ratio (Table 1). Median age at initial diagnosis was significantly higher with increasing severity of the categories of premalignant gastric lesions (P < .001) (Table 1). Women were significantly older than men at the initial diagnosis of atrophic gastritis (median age 63.2 years vs 57.8 years), intestinal metaplasia (68.7 vs 64.6), mild-to-moderate dysplasia (70.9 vs
Discussion
This large, nationwide study shows that patients with premalignant gastric lesions carry a significant risk of gastric cancer within 10 years of follow-up (Figure 6). However, in Dutch clinical practice, which is likely to be representative for many Western countries, surveillance of these patients is regularly omitted, even in patients with overt dysplasia.
Within 5 years of follow-up, the annual incidence of gastric cancer in our Western population was 0.1% for patients with atrophic
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All authors have contributed to the conception and design and interpretation of the data, and the drafting of the article or critical revision. A.C. de Vries and C.W.N. Looman analyzed the data. The authors have no conflict of interest to disclose.