Health Policy Research Center, Institute of Health, Student Research Committee.
Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
J Clin Gastroenterol. 2019 Nov/Dec;53(10):703-710. doi: 10.1097/MCG.0000000000001257.
Several studies have reported the risk of progression to gastric adenocarcinoma (GAC) in patients with gastric dysplasia (GD); however, the findings are controversial. We performed a systematic review and meta-analysis to study the incidence rate of GAC among patients with GD. Using a comprehensive search strategy, we systematically searched online databases including PubMed, Scopus, EMBASE, Cochrane Library, and Web of Science databases for identifying all relevant original articles through inception until July 2018. Cochran Q and I tests were used to assess heterogeneities between included studies. The incidence rates of GAC and their corresponding 95% confidence intervals (CIs) were pooled using random-effect or fixed-effect models. Of the 1980 retrieved records, 30 eligible articles (61 studies) were included. The overall pooled incidence rate of GAC was 40.36 (95% CI, 27.08-55.71; I, 96.0%) cases per 1000 person-years in patients with GD. Subgroup analysis according to the type of GD indicated the highest incidence rate of GAC was 186.40 (95% CI, 106.63-285.60; I, 94.6%) per 1000 person-years among patients with high-grade dysplasia (HGD) lesions. Although the incidence rates of GAC in low-grade dysplasia (LGD) lesions and in nonclassified lesions were 11.25 (95% CI, 3.91-21.22; I, 89.3%), and 1.40 (95% CI, 0.00-9.71; I, 78.8%), respectively. Compared with patients with LGD lesions, progression rate from GD to GAC was roughly 16 times greater in patients with HGD lesions. As the majority of patients with GAC are diagnosed in an advanced stage our study suggests strict management of HGD lesions to prevent GAC.
几项研究报告了胃异型增生（GD）患者进展为胃腺癌（GAC）的风险；然而，研究结果存在争议。我们进行了一项系统评价和荟萃分析，以研究 GD 患者中 GAC 的发生率。使用全面的搜索策略，我们系统地搜索了在线数据库，包括 PubMed、Scopus、EMBASE、Cochrane 图书馆和 Web of Science 数据库，以从开始到 2018 年 7 月确定所有相关的原始文章。使用 Cochran Q 和 I 检验评估纳入研究之间的异质性。使用随机效应或固定效应模型汇总 GAC 的发生率及其相应的 95%置信区间（CI）。在 1980 条检索记录中，有 30 篇符合条件的文章（61 项研究）纳入分析。GD 患者中 GAC 的总体汇总发生率为 40.36（95%CI，27.08-55.71；I，96.0%）例/1000 人年。根据 GD 类型进行的亚组分析表明，高级别异型增生（HGD）病变患者中 GAC 的最高发生率为 186.40（95%CI，106.63-285.60；I，94.6%）例/1000 人年。虽然低级别异型增生（LGD）病变和未分类病变的 GAC 发生率分别为 11.25（95%CI，3.91-21.22；I，89.3%）和 1.40（95%CI，0.00-9.71；I，78.8%）。与 LGD 病变患者相比，HGD 病变患者从 GD 进展为 GAC 的速度大约快 16 倍。由于大多数 GAC 患者被诊断为晚期，因此我们的研究建议严格管理 HGD 病变以预防 GAC。
