Increased Risk of Progression to Gastric Adenocarcinoma in Patients with Non-dysplastic Gastric Intestinal Metaplasia Ve
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ORIGINAL ARTICLE
Increased Risk of Progression to Gastric Adenocarcinoma in Patients with Non‑dysplastic Gastric Intestinal Metaplasia Versus a Control Population Rohit Dhingra1 · Nikola S. Natov2 · Yazan Daaboul1 · Moises Guelrud2 · Abraham Cherukara3 · Pu Fang Hung3 · Mark J. Sterling2 Received: 25 May 2019 / Accepted: 24 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Aim In previous studies, the 5-year progression rate of gastric intestinal metaplasia to gastric adenocarcinoma has varied substantially. We investigated the incidence rate of dysplasia and gastric adenocarcinoma and the rate of progression among a cohort of patients with non-dysplastic gastric intestinal metaplasia. Methods This is a single-center, single-cohort retrospective study. Patients who had undergone an EGD with biopsies from 01/01/1993 to 12/31/2013 were included. The primary outcome of interest was the composite of low-grade dysplasia, highgrade dysplasia, or adenocarcinoma. Time to progression and risk factor subgroup analyses were performed. Results A total of 1628 subjects were screened, of whom 358 met the inclusion criteria. A total of 21 first-time events were recorded. The annual incidence rate of low-grade dysplasia was 2.1 (95% CI 1.3–3.5) cases per 1000 person-years, 0.5 (95% 0.2–1.3) per 1000 person-years for high-grade dysplasia, and 0.8 (95% CI 0.3–1.6) cases per 1000 person-years for gastric adenocarcinoma. The historical control group had an annual adenocarcinoma incidence rate of 0.07 per 1000 person-years. The event rate in Asians was also noted to be significantly higher between years 0–8 as compared with patients of non-Asian race, and extensive intestinal metaplasia was an independent risk factor (HR = 4.06 (95% CI 1.45–11.34), p = 0.007). Conclusions Patients with non-dysplastic gastric intestinal metaplasia may progress to dysplasia and gastric adenocarcinoma. The incidence rate of gastric adenocarcinoma is higher than that of the historical control population (0.07 per 1000 personyears). The presence of extensive intestinal metaplasia was a risk factor for progression of disease. Triennial EGD may be warranted in patients with non-dysplastic gastric intestinal metaplasia. Keywords Metaplasia · Dysplasia · Gastric cancer · Surveillance · Endoscopy · Risk factors
Introduction Gastric cancer is the fifth most common malignancy and third leading cause of cancer-related death worldwide. Despite a decreasing incidence rate in Western countries,
the overall number of cases globally is projected to increase in the future due to an aging population. The majority of gastric cancer cases occur in developing parts of the world, such as East Asia, Eastern Europe, and Central and South America [1, 2]. In the USA, gastric cancer incidence is low
* Nikola S. Natov [email protected]
Pu Fang Hung [email protected]
Rohit Dhingra [email protected]
Mark J. Sterling [email protected]
Yazan Daaboul [email protected]
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