Atrophic-gastritis grade adequate for stratifying gastric cancer risk

Last Updated: 2018-10-24

By Reuters Staff

NEW YORK (Reuters Health) - Mucosal-atrophy grade alone can be used to stratify gastric-cancer risk, new research shows.

"Risk stratification was possible based on endoscopic examination alone. The (screening) interval should be set depending on each case," Dr. Kyosuke Kaji and colleagues from Kanazawa Medical Association in Ishikawa, Japan, conclude in the American Journal of Gastroenterology, online October 12.

Gastric cancer kills more than 40,000 people in Japan annually, and it is the second leading cause of cancer death for males and the fourth for females, Dr. Kaji and his team note.

Several local governments have introduced population-based gastric-cancer screening, which "must be more cost-effective in local areas that have limited medical resources available," the researchers add. "For screenings to be effective, screening intervals must be individually determined according to risk factors."

The authors looked at risk factors for gastric cancer in 9,378 residents of Kanazawa, a city in Ishikawa prefecture, who had received both endoscopic screening and medical exams in 2009-2015 and had at least one additional cancer screening by 2016.

In a second analysis, they looked at 12,941 people who underwent endoscopic screening at least twice in 2009-2015, with or without medical exams.

Aging, advanced atrophy, ulcers and uric acid levels were independent risk factors for gastric cancer overall, the authors found. Advanced atrophy and aging were the only statistically significant risk factors in subjects who underwent Helicobacter pylori (HP) eradication.

Annual gastric cancer occurrence rate was 0.39% for subjects with the most severe mucosa atrophy, compared to 0.10% for those with no atrophy or less severe atrophy and 0.16% for patients with moderate atrophy.

"The rates of gastric cancer occurrence in the three groups classified based on atrophy grade were all statistically significant overall. Therefore, the subjects with absent and C-1 should be considered as a low-risk group, C-2 and C-3 as moderate, and O-1 and over as high," Dr. Kaji and colleagues write.

Because there was no statistically significant difference in gastric cancer risk between the low- and moderate-risk groups after age 62, they add, "the C-2 and C-3 group may be treated in the same way as the absent and C-1 group in older age."

SOURCE: https://go.nature.com/2z43CIH

Am J Gastroenterol 2018.