Burke Eoghan, Harkins Patricia, Arumugasamy Mayilone
Surgery, Royal College of Surgeons in Ireland (RCSI), Dublin, IRL.
Medicine, Royal College of Physicians of Ireland (RCPI), Dublin, IRL.
Cureus. 2024 Oct 18;16(10):e71768. doi: 10.7759/cureus.71768. eCollection 2024 Oct.
Gastric atrophy (GA), or atrophic gastritis, is a pre-neoplastic lesion of gastric cancer (GC). It is part of the Correa cascade, which culminates in intestinal-type gastric adenocarcinoma. The cascade posits that intestinal-type gastric adenocarcinoma develops along a defined pathway of pre-neoplastic stages. The cascade begins with chronic gastritis, most commonly caused by Helicobacter pylori (H. pylori) infection, and proceeds through GA, gastric intestinal metaplasia (GIM), both complete and incomplete, dysplasia, both low and high-grade, and culminating in intestinal-type gastric adenocarcinoma. Attempts in Europe have been made to identify patients at risk of developing GC and target them with surveillance oesophagogastroduodenoscopy (OGD). However, there remains uncertainty about GA's risk of developing into GC. This poses issues in terms of guiding the need for and determining intervals for surveillance OGDs, which are a costly form of surveillance. As such, we attempted to gather all available studies assessing the risk of GC developing from GA, which is the first step in the Correa cascade. This study was a comprehensive systematic review of published papers, reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. This systematic review, which included a substantial 25,455 patients across 18 studies, found that the relative risk (RR) of GC in those with GA, using standardised incidence ratios as a measure of RR, was 15.1, with a 95% confidence interval ranging from 13.5 to 16.9. We conclude that GA does increase the risk of developing GC, and this risk may be higher than previously appreciated. Further large-scale studies are needed in Western cohorts of patients to precisely define this risk and guide the need for surveillance programs. These future studies must be standardised to account for H. pylori status, the topographical distribution of the GA, and the methods for assessing the degree of GA.
胃萎缩（GA），即萎缩性胃炎，是胃癌（GC）的一种癌前病变。它是科雷亚级联反应的一部分，最终发展为肠型胃癌。该级联反应认为，肠型胃癌沿着特定的癌前阶段途径发展。级联反应始于慢性胃炎，最常见的病因是幽门螺杆菌（H. pylori）感染，接着发展为GA、胃肠化生（GIM，包括完全型和不完全型）、异型增生（低级别和高级别），最终发展为肠型胃癌。欧洲已尝试识别有患GC风险的患者，并通过监测食管胃十二指肠镜检查（OGD）对其进行针对性检查。然而，GA发展为GC的风险仍存在不确定性。这在指导监测OGD的必要性和确定监测间隔方面带来了问题，因为OGD是一种成本高昂的监测形式。因此，我们试图收集所有评估GA发展为GC风险的现有研究，这是科雷亚级联反应的第一步。本研究是对已发表论文的全面系统评价，按照系统评价和Meta分析的首选报告项目（PRISMA）声明进行报告。这项系统评价纳入了18项研究中的25455名患者，发现以标准化发病率比作为相对风险（RR）的衡量指标，GA患者发生GC的RR为15.1，95%置信区间为13.5至16.9。我们得出结论，GA确实会增加患GC的风险，而且这种风险可能比之前认为的更高。需要在西方患者队列中进行进一步的大规模研究，以精确界定这种风险并指导监测项目的必要性。未来的这些研究必须标准化，以考虑幽门螺杆菌感染状况、GA的部位分布以及评估GA程度的方法。
