Biomarkers improve risk stratification of patients with premalignant gastric lesions

Last Updated: 2018-06-22

By Will Boggs MD

NEW YORK (Reuters Health) - Serological biomarkers could improve risk stratification of patients with premalignant gastric lesions and thereby individualize surveillance strategies, Dutch researchers report.

"Addition of serology markers might help in better discrimination between low- and high-risk patients," Dr. Wouter J. den Hollander from Erasmus University Medical Center, in Rotterdam, told Reuters Health by email. "Results need to be validated and follow-up time extended, but if true, the implication would be that the majority of patients do not need surveillance."

International guidelines recommend endoscopic surveillance of premalignant gastric lesions, because they predispose to the development of intestinal-type gastric cancer. Identification of patients with an increased gastric-cancer risk remains challenging, as is determination of optimal surveillance strategies.

Dr. den Hollander and colleagues used data from 279 patients with a previous diagnosis of atrophic gastritis (AG, 4%), intestinal metaplasia (IM, 87%), or dysplasia (9%) to assess the incidence of neoplastic progression and to assess the ability of various tests to identify patients most at risk for progression.

H. pylori serology was positive in 51% of patients, but less than 20% of these were persistently H. pylori-positive based on histology, meaning that most patients had successfully undergone eradication treatment.

Only 4% of patients showed progression on surveillance endoscopy, with only 1.4% (4/279) progressing to a visible dysplastic or invasive neoplasia lesion (equivalent to one case of progression to neoplasia per 328 patient-years), the team reports in Gut, online June 6.

During a mean 50.8 months' follow-up, 42% of cases regressed to a lower operative link on gastric intestinal metaplasia (OLGIM) stage, 35% did not change OLGIM stage and 23% progressed to a higher OLGIM stage.

Mean serological levels of pepsinogen (PG) I, PGI/PGII, and gastrin-17 differed significantly between OLGIM categories, but were not consistently correlated with an increase in OLGIM stage.

Progression was observed in 16% of patients classified as low-risk according to the MAnagement of Precancerous conditions of the Stomach (MAPS) guidelines versus only 2% in those classified as high-risk.

When histological and serological results were combined to divide patients into low-risk (AG/IM limited to antrum and normal biomarkers) and high-risk (AG/IM in both antrum and corpus and/or abnormal biomarkers), no patients in the low-risk group progressed to high-grade dysplasia/invasive neoplasia, compared with three patients in the high-risk group.

Neoplastic progression occurred in the same proportion of patients with low OLGIM grade (0-II) compared with high OLGIM grade (III-IV) at index endoscopy.

"These results seem to indicate that a risk stratification tool solely based on histopathology might not be sufficient," the researchers note. "Given the small number of cases and the limited follow-up of this study we acknowledge that a strong conclusion can only be made based on more cases and longer follow-up."

"We highly need additional markers next to the histopathology results, in order to select the right patients for surveillance," Dr. den Hollander said. "Until now, there is too little evidence to draw hard conclusions, but our results may stimulate research on this topic and provide input for international guidelines."

SOURCE: https://bit.ly/2tlJeQu

Gut 2018.