Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, China.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, 17177, Sweden.
BMC Med. 2024 Aug 15;22(1):333. doi: 10.1186/s12916-024-03554-1.
The Correa's cascade, encompassing chronic non-atrophic gastritis, atrophic gastritis, intestinal metaplasia, and dysplasia, represents the well-recognized pathway for the development of non-cardia gastric cancer. Population-based studies on all-cause and cause-specific mortalities among patients with gastric lesions in Correa's cascade are scarce.
We compiled a cohort of 340 744 eligible patients who had undergone endoscopy with biopsy for non-malignant indications during the period 1979-2011, which was followed up until 2014. Standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) provided estimation of the relative risk, using the general Swedish population as reference. Cox regression model was used to estimate hazard ratios (HRs) of death for internal comparison.
A total of 306 117 patients were included in the final analysis, accumulating 3,049,009 person-years of follow-up. In total 106,625 deaths were observed during the study period. Compared to the general population, excess risks of overall mortality were noted in all subgroups, with SMRs ranging from 1.11 (95% CI 1.08-1.14) for the normal mucosa group to 1.54 (95% CI 1.46-1.62) for the dysplasia group. For cause-specific mortalities, mortality from gastric cancer gradually increased along Correa's cascade, with excess risk rising from 105% for patients with chronic gastritis to more than 600% for the dysplasia group. These results were confirmed in the comparison with the normal mucosa group. For non-cancer conditions, increased death risks were noted for various diseases compared to the general population, especially among patients with more severe gastric precancerous lesions. But the results were confirmed only for "infectious diseases and parasitic diseases", "respiratory system diseases", and "digestive system disease", when using the normal mucosa group as reference.
Increased mortality from gastric cancer suggests that early recognition and intervention of gastric precancerous lesions probably benefit the patients. Excess mortality due to non-cancer conditions should be interpreted with caution, and future studies are warranted.
科雷亚级联反应包括慢性非萎缩性胃炎、萎缩性胃炎、肠上皮化生和异型增生，代表了非贲门胃癌发展的公认途径。关于科雷亚级联反应中胃病变患者的全因和特定原因死亡率的基于人群的研究很少。
我们编制了一个队列，其中包括 340744 名符合条件的患者，这些患者在 1979 年至 2011 年期间因非恶性指征接受了内镜活检，随访至 2014 年。使用一般瑞典人群作为参考，标准化死亡率比（SMRs）及其 95%置信区间（CIs）用于估计相对风险。使用 Cox 回归模型对内比较死亡的风险比（HRs）进行估计。
共有 306117 名患者纳入最终分析，共积累了 3049009 人年的随访。在研究期间共观察到 106625 例死亡。与一般人群相比，所有亚组均观察到全因死亡率的超额风险，SMRs 范围从正常黏膜组的 1.11（95%CI 1.08-1.14）到异型增生组的 1.54（95%CI 1.46-1.62）。对于特定原因的死亡率，随着科雷亚级联反应的进展，胃癌死亡率逐渐增加，从慢性胃炎患者的 105%增加到异型增生组的 600%以上。这些结果在与正常黏膜组的比较中得到了证实。对于非癌症疾病，与一般人群相比，各种疾病的死亡风险增加，尤其是在患有更严重胃癌前病变的患者中。但是，当使用正常黏膜组作为参考时，仅在“传染病和寄生虫病”、“呼吸系统疾病”和“消化系统疾病”中证实了这些结果。
胃癌死亡率的增加表明，早期识别和干预胃癌前病变可能对患者有益。对于非癌症疾病的超额死亡率应谨慎解释，需要进一步研究。
