Incidence of gastric cancer among patients with gastric precancerous lesions: observational cohort study in a low risk Western population
نویسندگان
چکیده
OBJECTIVE To accurately measure the incidence of gastric cancer among patients with gastric precancerous lesions, and to quantify the excess incidence in comparison with people with normal mucosa on endoscopy and a general population. DESIGN Population based cohort study. SETTING Population of Sweden using data from its national disease registers. PARTICIPANTS 405,172 patients who had gastric biopsy samples taken for non-malignant indications between 1979 and 2011. MAIN OUTCOME MEASURES Incidence of gastric cancer, reported separately for patients with different mucosal changes in biopsy samples. Standardised incidence ratios provided estimation of the relative risk, using the general Swedish population as reference; and hazard ratios were derived from Cox regression modelling for internal comparisons with patients with normal gastric mucosa. RESULTS After excluding the first two years of follow-up, 1599 cases of gastric cancer were identified. The annual crude incidence of gastric cancer was 20 × 10(-5) for those in the normal mucosa group (standardised incidence ratio 1.0), 42 × 10(-5) for those with minor changes (1.5), 59 × 10(-5) for the gastritis group (1.8), 100 × 10(-5) for the atrophic gastritis group (2.8), 129 × 10(-5) for the intestinal metaplasia group (3.4), and 263 × 10(-5) for the dysplasia group (6.5). Cox regression modelling confirmed that excess risks increased monotonically with progressive severity of gastric lesions, with the highest hazard ratio of 10.9 (dysplasia versus normal mucosa, 95% confidence interval 7.7 to 15.4). The increased incidence was stable throughout the follow-up period, and the gaps between cumulative incidence curves grew continuously. CONCLUSIONS Among patients who undergo gastroscopy with biopsy for clinical indications, approximately 1 in 256 with normal mucosa, 1 in 85 with gastritis, 1 in 50 with atrophic gastritis, 1 in 39 with intestinal metaplasia, and 1 in 19 with dysplasia will develop gastric cancer within 20 years. These numbers, along with cost-benefit analyses, should guide future surveillance policies for these particular patient groups.
منابع مشابه
ارزش بیومارکرهای معده ای در شناسایی ضایعات پیش سرطانی در بیماران دیس پپسی
Background and purpose: Identifying precancerous lesions for early detection of gastric cancer is greatly important in high risk areas for stomach cancer. In this study, we evaluated stomach biomarkers as a non-invasive method for recognition of gastric precancerous lesions. Materials and methods: In a cross-sectional study, patients with chronic dyspeptic symptoms who were candidate for endos...
متن کاملبررسی عوامل احتمالی موثر در ایجاد سرطان معده در 90 بیمار
In this observational case control survey, ninty patients with histologic diagnosis of gastric cancer from two university hospitals were studied retrospectively. A sizable 50 % of the patients were farmers who lived in the remote and under developed rural areas being in contact with nitrate fertilizer and nitrated soil and having little or no access to the modern food storage and preservations ...
متن کاملStudy of Association Between TLR4 D299G and T399I Polymorphisms and Risk of Gastric Cancer
Introduction:Gastrointestinal cancers constitute more than one-third of the most common cancers and half of the fatal cancers worldwide. Toll-like receptors (TLRs) are identified as pivotal receptors in innate immunity responses. TLR4 is the main receptor that plays a role in lipopolysaccharide (LPS) sensing of gram-positive bacteria. D299G (rs4986790)&...
متن کاملStudy of Association Between TLR4 D299G and T399I Polymorphisms and Risk of Gastric Cancer
Introduction:Gastrointestinal cancers constitute more than one-third of the most common cancers and half of the fatal cancers worldwide. Toll-like receptors (TLRs) are identified as pivotal receptors in innate immunity responses. TLR4 is the main receptor that plays a role in lipopolysaccharide (LPS) sensing of gram-positive bacteria. D299G (rs4986790)&...
متن کاملThe Association Between C194T and G399A Polymorphism of XRCC1 Gene and Susceptibility to Gastric Cancer in the People Living in the Western Part of Iran
Background: Gastric cancer is one of the most common malignancies in the world. It may result from a defect in the genes involved in DNA repair. One of the essential genes in the repair pathway is the XRCC1 gene that its polymorphisms in the human population play a role in gastric cancer susceptibility. The main purpose of this study was to investigate the association of 194C/T and 399G/A polym...
متن کامل