Center for Cancer Prevention and Detection, National Cancer Center, Goyang, Republic of Korea.
Cancer. 2012 Oct 15;118(20):4953-60. doi: 10.1002/cncr.27495. Epub 2012 Jul 16.
Endoscopy screening in high-risk populations may reduce gastric cancer mortality by detecting cancer earlier. We evaluated the association between the interval between upper gastrointestinal endoscopies and the gastric cancer stage at diagnosis in patients from a region of high prevalence.
The study cohort consisted of 2485 patients diagnosed with gastric adenocarcinoma. We evaluated the effect on cancer stage of the interval between the endoscopy that was diagnostic for gastric cancer and the endoscopy preceding it. Patients were stratified into 7 groups: 1-, 2-, 3-, 4-, 5-, >5-year intervals and those who were never screened.
The risk of higher cancer stage at diagnosis increased by 23% per increase in interval length (odds ratio = 1.23, 95% confidence interval [CI] = 1.19-1.28). Compared to the never-screened, the odds ratio of having a higher stage of cancer decreased gradually from 0.53 (95% CI = 0.41-0.69) in the >5-year interval group to 0.31 (95% CI = 0.24-0.40) in the 1-year interval group. Compared to the 1-year interval group, the risk of advanced gastric cancer was increased in the 4- and 5-year, but not the 2- and 3-year, interval groups. However, patients with a family history of gastric cancer were more likely to have a higher stage at diagnosis if they had a 3-year interval rather than a 1-year interval.
A significant benefit in cancer stage at diagnosis was observed in all interval groups compared to never-screened. Endoscopy intervals of 3 years or less showed similar benefits, but family members of gastric cancer patients may benefit from intervals of under 3 years.
在上消化道内镜筛查高危人群中，通过更早地发现癌症，可降低胃癌死亡率。我们评估了高发地区人群中，上消化道内镜检查间隔时间与诊断时胃癌分期的相关性。
研究队列包括 2485 名被诊断为胃腺癌的患者。我们评估了内镜检查诊断为胃癌与前一次内镜检查之间的间隔时间对癌症分期的影响。患者被分为 7 组：1 年、2 年、3 年、4 年、5 年、>5 年，以及从未筛查过的患者。
间隔时间每增加 1 年，诊断时癌症分期更高的风险增加 23%（比值比=1.23，95%置信区间[CI]为 1.19-1.28）。与从未筛查过的患者相比，间隔时间>5 年组患癌症分期更高的比值比逐渐降低，从 0.53（95%CI=0.41-0.69）降至 1 年间隔组的 0.31（95%CI=0.24-0.40）。与 1 年间隔组相比，4 年和 5 年间隔组的胃癌进展风险增加，但 2 年和 3 年间隔组则不然。然而，如果有胃癌家族史，与 1 年间隔相比，3 年间隔的患者更有可能被诊断为晚期癌症。
与从未筛查过的患者相比，所有间隔组的诊断时癌症分期都有显著获益。3 年或更短的内镜检查间隔时间具有相似的获益，但胃癌患者的家属可能受益于间隔时间不到 3 年。
