Gastroenterology

Gastroenterology

Volume 134, Issue 4, April 2008, Pages 945-952
Gastroenterology

Clinical–Alimentary Tract
Gastric Cancer Risk in Patients With Premalignant Gastric Lesions: A Nationwide Cohort Study in the Netherlands

https://doi.org/10.1053/j.gastro.2008.01.071Get rights and content

Background & Aims: A cascade of precursor lesions (eg, atrophic gastritis, intestinal metaplasia, and dysplasia) precedes most gastric adenocarcinomas. Quantification of gastric cancer risk in patients with premalignant gastric lesions is unclear, however. Consequently, endoscopic surveillance is controversial, especially in Western populations. Methods: To analyze current surveillance practice and gastric cancer risk in patients with premalignant gastric lesions, all patients with a first diagnosis between 1991 and 2004 were identified in the Dutch nationwide histopathology registry (PALGA); follow-up data were evaluated until December 2005. Results: In total, 22,365 (24%) patients were diagnosed with atrophic gastritis, 61,707 (67%) with intestinal metaplasia, 7616 (8%) with mild-to-moderate dysplasia, and 562 (0.6%) with severe dysplasia. Patients with a diagnosis of atrophic gastritis, intestinal metaplasia, or mild-to-moderate dysplasia received re-evaluation in 26%, 28%, and 38% of cases, respectively, compared with 61% after a diagnosis of severe dysplasia (P < .001). The annual incidence of gastric cancer was 0.1% for patients with atrophic gastritis, 0.25% for intestinal metaplasia, 0.6% for mild-to-moderate dysplasia, and 6% for severe dysplasia within 5 years after diagnosis. Risk factors for gastric cancer development were increasing severity of premalignant gastric lesions at initial diagnosis (eg, severe dysplasia, hazard ratio 40.14, 95% confidence interval 32.2–50.1), increased age (eg, 75–84 years, hazard ratio 3.75, 95% confidence interval 2.8–5.1), and male gender (hazard ratio 1.50, 95% CI 1.3–1.7). Conclusions: Patients with premalignant gastric lesions are at considerable risk of gastric cancer. As current surveillance of these patients is inconsistent with their cancer risk, development of guidelines is indicated.

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.

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