Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS: BCM 285, Houston, TX, 77030-3498, USA.
Division of Gastrointestinal and Liver Disease, University of Southern California, Los Angeles, CA, USA.
Dig Dis Sci. 2023 Mar;68(3):761-769. doi: 10.1007/s10620-022-07587-5. Epub 2022 Jun 11.
Screening for gastric cancer is not recommended despite rising rates in certain U.S.
We determined possible missed opportunities for the detection and surveillance of preneoplastic lesions among gastric cancer patients in a VA hospital.
This retrospective cohort study included consecutive, newly diagnosed non-cardia gastric adenocarcinoma patients from 11/2007 to 10/2018 at the Houston VA Hospital. We identified missed opportunities for screening based on risk factors (non-White race, smoking, alcohol, Helicobacter pylori infection, gastric ulcers, family history of gastric cancer). We additionally determined missed opportunities for surveillance of known high-risk lesions. Associations between receipt of prior endoscopy for screening or surveillance and cancer-related outcomes (stage, treatment, survival) were determined using logistic regression models.
Among 91 gastric cancer patients, 95.6% were men, 51.6% were black, 12.1% were Hispanic, with mean age of 68.0 years (standard deviation 10.8 years). The most common risk factors included non-white race (68.1%), smoking (76.9%), alcohol use (59.3%) and prior H. pylori (12.1%). Most patients had ≥ 1 risk factor for gastric cancer (92.6%), and 76.9% had ≥ 2 risk factors. Only 25 patients (27.5%) had undergone endoscopy prior to cancer diagnosis. Of 14 with known high-risk lesions (i.e., gastric intestinal metaplasia, dysplasia, ulcer), only 2 (14.3%) underwent surveillance endoscopy. Receipt of prior endoscopy was not associated with differences in cancer outcomes.
Most patients with newly diagnosed gastric cancer had ≥ 2 known risk factors for gastric cancer but never received prior screening endoscopy. Among the few with known prior preneoplastic lesions, endoscopic surveillance was not consistently performed.
尽管某些美国人群的胃癌发病率上升，但不建议进行胃癌筛查。
本回顾性队列研究纳入了 2007 年 11 月至 2018 年 10 月在休斯顿退伍军人事务医院新诊断的连续非贲门胃腺癌患者。我们根据危险因素（非白种人、吸烟、饮酒、幽门螺杆菌感染、胃溃疡、胃癌家族史）确定了胃肿瘤患者筛查中可能错过的机会。我们还确定了已知高危病变监测的机会错过。使用逻辑回归模型确定接受先前内镜检查筛查或监测与癌症相关结局（分期、治疗、生存）之间的关联。
在 91 例胃癌患者中，95.6%为男性，51.6%为黑人，12.1%为西班牙裔，平均年龄 68.0 岁（标准差 10.8 岁）。最常见的危险因素包括非白种人（68.1%）、吸烟（76.9%）、饮酒（59.3%）和既往幽门螺杆菌感染（12.1%）。大多数患者有≥1 个胃癌危险因素（92.6%），76.9%有≥2 个危险因素。仅有 25 例（27.5%）患者在癌症诊断前接受过内镜检查。在 14 例已知高危病变（即胃肠上皮化生、异型增生、溃疡）患者中，仅 2 例（14.3%）接受了内镜监测。接受先前内镜检查与癌症结局无差异。
大多数新诊断为胃癌的患者有≥2 个已知的胃癌危险因素，但从未接受过先前的筛查性内镜检查。在少数已知有癌前病变的患者中，并未始终进行内镜监测。
