Division of Gastroenterology and Hepatology, National University Hospital, Singapore.
Department of Medicine, National University of Singapore, Singapore.
Gut. 2022 May;71(5):854-863. doi: 10.1136/gutjnl-2021-324057. Epub 2021 May 11.
To investigate the incidence of gastric cancer (GC) attributed to gastric intestinal metaplasia (IM), and validate the Operative Link on Gastric Intestinal Metaplasia (OLGIM) for targeted endoscopic surveillance in regions with low-intermediate incidence of GC.
A prospective, longitudinal and multicentre study was carried out in Singapore. The study participants comprised 2980 patients undergoing screening gastroscopy with standardised gastric mucosal sampling, from January 2004 and December 2010, with scheduled surveillance endoscopies at year 3 and 5. Participants were also matched against the National Registry of Diseases Office for missed diagnoses of early gastric neoplasia (EGN).
There were 21 participants diagnosed with EGN. IM was a significant risk factor for EGN (adjusted-HR 5.36; 95% CI 1.51 to 19.0; p<0.01). The age-adjusted EGN incidence rates for patients with and without IM were 133.9 and 12.5 per 100 000 person-years. Participants with OLGIM stages III-IV were at greatest risk (adjusted-HR 20.7; 95% CI 5.04 to 85.6; p<0.01). More than half of the EGNs (n=4/7) attributed to baseline OLGIM III-IV developed within 2 years (range: 12.7-44.8 months). Serum trefoil factor 3 distinguishes (Area Under the Receiver Operating Characteristics 0.749) patients with OLGIM III-IV if they are negative for . Participants with OLGIM II were also at significant risk of EGN (adjusted-HR 7.34; 95% CI 1.60 to 33.7; p=0.02). A significant smoking history further increases the risk of EGN among patients with OLGIM stages II-IV.
We suggest a risk-stratified approach and recommend that high-risk patients (OLGIM III-IV) have endoscopic surveillance in 2 years, intermediate-risk patients (OLGIM II) in 5 years.
调查归因于胃肠化生（IM）的胃癌（GC）发病率，并验证针对 GC 低-中发地区的靶向内镜监测的手术链接胃肠化生（OLGIM）。
在新加坡进行了一项前瞻性、纵向和多中心研究。该研究的参与者包括 2980 名接受标准胃黏膜采样筛查胃镜检查的患者，时间为 2004 年 1 月至 2010 年 12 月，在第 3 年和第 5 年进行计划的内镜监测。参与者还与国家疾病登记处进行了对比，以查找早期胃癌（EGN）的漏诊病例。
有 21 名参与者被诊断为 EGN。IM 是 EGN 的显著危险因素（调整后的 HR 5.36；95%CI 1.51 至 19.0；p<0.01）。有和没有 IM 的患者的年龄调整 EGN 发病率分别为 133.9 和 12.5 例/100000 人年。OLGIM 分期 III-IV 期的患者风险最大（调整后的 HR 20.7；95%CI 5.04 至 85.6；p<0.01）。超过一半的 EGN（n=4/7）归因于基线 OLGIM III-IV，发生在 2 年内（范围：12.7-44.8 个月）。血清三叶因子 3（TFF3）如果患者的 OLGIM III-IV 为阴性，则可以区分（受试者工作特征曲线下面积 0.749）。OLGIM II 的患者也有发生 EGN 的显著风险（调整后的 HR 7.34；95%CI 1.60 至 33.7；p=0.02）。显著的吸烟史进一步增加了 OLGIM 各期患者的 EGN 风险。
我们建议采用风险分层方法，建议高危患者（OLGIM III-IV）在 2 年内进行内镜监测，中危患者（OLGIM II）在 5 年内进行监测。
