Office of National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Int J Cancer. 2021 Nov 1;149(9):1639-1648. doi: 10.1002/ijc.33720. Epub 2021 Jul 7.
In our study, we aimed to assess the long-term risk of gastric cardia adenocarcinoma (GCA) for patients with different histological cardia lesions to inform future guidelines for GCA screening in China. We conducted a population-based prospective study among 9740 subjects who underwent upper endoscopy screening during 2005 to 2009 and followed until December 2017. Cumulative incidence and mortality rates of GCA were calculated by the baseline histological diagnoses, and the hazard ratios (HRs), overall and by age and sex, were analyzed by Cox proportional hazards models. During a median follow-up of 10 years, we identified 123 new GCA cases (1.26%) and 31 GCA deaths (0.32%). The age-standardized incidence and mortality rates of GCA were 128.71/100 000 and 35.69/100 000 person-years, and cumulative incidence rate in patients with cardia high-grade dysplasia (CHGD), cardia low-grade dysplasia (CLGD) and atrophic carditis (AC)/cardia intestinal metaplasia (CIM) was 25%, 3.05% and 1.58%, respectively. The progression rate and cancer risk of GCA increased monotonically with each step in Correa's cascade. Individuals aged 50 to 69 years had 4.4 times higher GCA incidence than those aged 40 to 49 years. Patients with CLGD had a significantly higher 3-year GCA incidence than the normal group, while patients with AC/CIM had a comparable GCA risk during 3-year follow-up but a higher risk at 5-year intervals. Our results suggested a postponed starting age of 50 years for GCA screening, immediate treatment for patients with CHGD, a 3-year surveillance interval for patients with CLGD, and a lengthened surveillance interval of 5 years for patients with AC/CIM.
在我们的研究中，我们旨在评估不同组织学贲门病变患者发生贲门腺癌（GCA）的长期风险，以为中国未来的 GCA 筛查指南提供信息。我们对 9740 名于 2005 年至 2009 年期间接受内镜筛查的受试者进行了一项基于人群的前瞻性研究，并随访至 2017 年 12 月。根据基线组织学诊断计算 GCA 的累积发病率和死亡率，并通过 Cox 比例风险模型分析总发病率和按年龄及性别分层的发病率比（HR）。在中位随访 10 年期间，我们发现 123 例新的 GCA 病例（1.26%）和 31 例 GCA 死亡病例（0.32%）。GCA 的年龄标准化发病率和死亡率分别为 128.71/100000 和 35.69/100000 人年，而在贲门高级别上皮内瘤变（CHGD）、贲门低级别上皮内瘤变（CLGD）和萎缩性胃炎/肠上皮化生（AC/CIM）患者中的累积发病率分别为 25%、3.05%和 1.58%。随着科雷亚级联反应的每一步进展，GCA 的进展率和癌症风险呈单调递增。50 至 69 岁的个体 GCA 发病率比 40 至 49 岁的个体高 4.4 倍。CLGD 患者的 3 年 GCA 发病率明显高于正常组，而 AC/CIM 患者在 3 年随访期间具有相当的 GCA 风险，但在 5 年随访间隔时风险更高。我们的结果表明，GCA 筛查的起始年龄可推迟至 50 岁，对 CHGD 患者应立即进行治疗，对 CLGD 患者应进行 3 年监测，对 AC/CIM 患者应延长监测间隔至 5 年。
