Hahn Anne I, Mülder Duco T, Huang Robert J, Zhou Margaret J, Blake Benjamin, Omofuma Omonefe, Murphy John D, Gutiérrez-Torres Daniela S, Zauber Ann G, O'Mahony James F, Camargo M Constanza, Ladabaum Uri, Yeh Jennifer M, Hur Chin, Lansdorp-Vogelaar Iris, Meester Reinier, Laszkowska Monika
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
Clin Gastroenterol Hepatol. 2024 Oct 1. doi: 10.1016/j.cgh.2024.09.003.
BACKGROUND & AIMS: Whether gastric cancer (GC) precursor lesions progress to invasive cancer at similar rates globally remains unknown. We conducted a systematic review and meta-analysis to determine the progression of precursor lesions to GC in countries with low versus medium/high incidence.
We searched relevant databases for studies reporting the progression of endoscopically confirmed precursor lesions to GC. Studies were stratified by low (<6 per 100,000) or medium/high (≥6 per 100,000) GC incidence countries. Random-effects models were used to estimate the progression rates of atrophic gastritis (AG), intestinal metaplasia (IM), and dysplasia to GC per 1000 person-years.
Among the 5829 studies identified, 44 met our inclusion criteria. The global pooled estimates of the progression rate per 1000 person-years were 2.09 (95% confidence interval, 1.46-2.99), 2.89 (2.03-4.11), and 10.09 (5.23-19.49) for AG, IM, and dysplasia, respectively. The estimated progression rates per 1000 person-years for low versus medium/high GC incidence countries, respectively, were 0.97 (0.86-1.10) versus 2.47 (1.70-2.99) for AG (P < .01), 2.37 (1.43-3.92) versus 3.47 (2.13-5.65) for IM (P = .29), and 5.51 (2.92-10.39) versus 14.80 (5.87-37.28) for dysplasia (P = .08). There were no differences for progression of AG between groups when high-quality studies were compared.
Similar progression rates of IM and dysplasia were observed among low and medium/high GC incidence countries. This suggests that the potential benefits of surveillance for these lesions in low-risk regions may be comparable with those of population-wide interventions in high-risk regions. Further prospective studies are needed to confirm these findings and inform global screening and surveillance guidelines.
全球范围内，胃癌（GC）前体病变进展为浸润性癌的速率是否相似尚不清楚。我们进行了一项系统评价和荟萃分析，以确定低发病率国家与中/高发病率国家前体病变进展为胃癌的情况。
我们在相关数据库中检索报告经内镜确认的前体病变进展为胃癌的研究。研究按胃癌低发病率（每10万人中<6例）或中/高发病率（每10万人中≥6例）国家进行分层。采用随机效应模型估计萎缩性胃炎（AG）、肠化生（IM）和异型增生每1000人年进展为胃癌的发生率。
在检索到的5829项研究中，44项符合我们的纳入标准。AG、IM和异型增生每1000人年进展率的全球合并估计值分别为2.09（95%置信区间，1.46 - 2.99）、2.89（2.03 - 4.11）和10.09（5.23 - 19.49）。低胃癌发病率国家与中/高胃癌发病率国家每1000人年的估计进展率，AG分别为0.97（0.86 - 1.10）和2.47（1.70 - 2.99）（P <.01），IM分别为2.37（1.43 - 3.92）和3.47（2.13 - 5.65）（P =.29），异型增生分别为5.51（2.92 - 10.39）和14.80（5.87 - 37.28）（P =.08）。比较高质量研究时，各组间AG的进展无差异。
在低胃癌发病率国家和中/高胃癌发病率国家中，观察到IM和异型增生的进展率相似。这表明在低风险地区对这些病变进行监测的潜在益处可能与在高风险地区进行全人群干预的益处相当。需要进一步的前瞻性研究来证实这些发现，并为全球筛查和监测指南提供依据。
