Occurrence of gastric cancer in patients with atrophic gastritis during long-term follow-up.

BACKGROUND

Additional data on the incidence of gastric neoplasia in the Chinese atrophic gastritis (AG) population during long-term follow-up are needed and the influence of the endoscopic surveillance interval on gastric neoplasia occurrence remains unknown.

AIMS

Retrospectively investigated the occurrence of gastric cancer (GC) and precancerous lesions in AG patients during long-term follow-up and assessed risk factors, such as the endoscopic surveillance interval for the development of gastric neoplasia.

METHODS

This study enrolled 332 AG patients who underwent initial gastroscopy from 2002 to 2005. Following parameters were collected: age, gender, smoking history, H. pylori infection, location of atrophy and intestinal metaplasia (IM), surveillance interval, follow-up duration, and neoplasia occurrence.

RESULTS

Gastric neoplasia was diagnosed in 16 patients. The annual incidence rates per person-year of total gastric neoplasia, gastric high-grade intraepithelial neoplasia (HGIN), early GC and advanced GC were 0.53%, 0.07%, 0.20% and 0.33%, respectively. A multivariate Cox analysis not accounting for the extent of AG and/or IM showed that the risk factors for GC development among AG patients included the presence of AG and/or IM involving both antral and corporal (p<.001, HR 2.898) and H. pylori infection (p=.018, HR 3.946). In the extensive AG and/or IM group, a 2- to 3-year surveillance interval might be instructive in early detection of GC (p=.008, HR 0.015).

CONCLUSIONS

Our data reveal an annual incidence rate of 0.53% per person-year for GC and HGIN in AG patients. A 2- to 3-year surveillance interval may be suitable for patients with extensive AG and/or IM.