Gastroenterology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal.
Gastroenterology Department, RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) and Porto Comprehensive Cancer Centre (Porto.CCC), Porto, Portugal.
Endoscopy. 2023 Oct;55(10):909-917. doi: 10.1055/a-2089-6849. Epub 2023 May 9.
Surveillance after gastric endoscopic submucosal dissection (ESD) is recommended for all patients owing to the persistent risk of metachronous gastric lesions (MGLs). We developed and validated a prediction score to estimate MGL risk after ESD for early neoplastic gastric lesions, to define an individualized and cost-saving approach.
Clinical predictors and a risk score were derived from meta-analysis data. A retrospective, single-center, cohort study including patients with ≥ 3 years of standardized surveillance after ESD was conducted for score validation. Predictive accuracy of the score by the area under the receiver operating characteristic curve (AUC) was assessed and cumulative probabilities of MGL were estimated.
The risk score (0-9 points) included six clinical predictors (scored 0-3): positive family history of gastric cancer, older age, male sex, corpus intestinal metaplasia, synchronous gastric lesions, and persistent infection (FAMISH). The study population included 263 patients. The MGL rate was 16 %. The score diagnostic accuracy for predicting MGL at 3 years' follow-up, measured by the AUC, was 0.704 (95 %CI 0.603-0.806). At 3 years and a cutoff < 2, the score achieved maximal sensitivity and negative predictive value; 15 % of patients could be assigned to a low-risk group, in which the progression to MGL was significantly lower than for the high-risk group ( = 0.04).
The FAMISH score might be a useful tool to accurately identify patients with low-to-intermediate risk for MGL at 3 years of follow-up who could have surveillance intervals extended to reduce the burden of care.
由于早期胃黏膜下剥离术（ESD）后仍存在发生胃黏膜异时性病变（MGL）的持续风险，建议对所有患者进行内镜监测。我们开发并验证了一种预测评分，以评估早期肿瘤性胃病变 ESD 后 MGL 的风险，从而确定个体化和具有成本效益的方法。
从荟萃分析数据中得出临床预测因子和风险评分。进行了一项回顾性、单中心队列研究，包括 ESD 后进行了≥3 年标准化监测的患者，以验证评分。通过接受者操作特征曲线（AUC）下的面积评估评分的预测准确性，并估计 MGL 的累积概率。
风险评分（0-9 分）包括 6 个临床预测因子（每项评分 0-3 分）：胃癌阳性家族史、年龄较大、男性、肠化生、同时存在胃病变和持续感染（FAMISH）。研究人群包括 263 例患者。MGL 发生率为 16%。评分在 3 年随访时预测 MGL 的准确性通过 AUC 衡量为 0.704（95%CI 0.603-0.806）。在 3 年和截断值<2 时，评分达到最大的敏感性和阴性预测值；可以将 15%的患者分配到低危组，该组中 MGL 的进展明显低于高危组（ = 0.04）。
FAMISH 评分可能是一种有用的工具，可以准确识别在 3 年随访时发生 MGL 的低至中等风险患者，从而可以延长监测间隔以减轻护理负担。
