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. 2015;91(1):30-6.
doi: 10.1159/000368807. Epub 2015 Jan 20.

Relationship between the degree of endoscopic atrophy of the gastric mucosa and carcinogenic risk

Hironori Masuyama  1 , Naoto Yoshitake, Takako Sasai, Tetsuya Nakamura, Atsushi Masuyama, Toru Zuiki, Kentaro Kurashina, Mitsuyo Mieda, Keijiro Sunada, Hironori Yamamoto, Kazutomo Togashi, Akira Terano, Hideyuki Hiraishi
Affiliations

Relationship between the degree of endoscopic atrophy of the gastric mucosa and carcinogenic risk

Hironori Masuyama et al. Digestion. 2015.

Abstract

Background: The relationship between Helicobacter pylori infection and gastric cancer has been demonstrated, and the risk of gastric cancer occurrence is known to increase with the progression of atrophic changes associated with chronic gastritis. Endoscopic evaluation of the degree and extent of atrophy of the gastric mucosa is a simple and very important means of identifying a group at high risk for gastric cancer. This study aimed to clarify the carcinogenic risk in relation to the degree of atrophy.

Methods: A total of 27,777 patients (272 with early gastric cancer and 135 with advanced gastric cancer) were included in this study. Endoscopically evaluated atrophy of the gastric mucosa was classified as C-0 to O-3 according to the Kimura and Takemoto classification system.

Results: The cancer detection rate in relation to the degree of gastric mucosal atrophy was 0.04% (2/4,183 patients) for C-0, 0% (0/4,506) for C-1, 0.25% (9/3,660) for C-2, 0.71% (21/2,960) for C-3, 1.32% (75/5,684) for O-1, 3.70% (140/3,780) for O-2 and 5.33% (160/3,004) for O-3. As to the proportions of differentiated and undifferentiated cancers, the latter were relatively frequent in the C-0 to C-2 groups, but differentiated cancers became predominant as atrophy progressed. On the other hand, the number of both differentiated and undifferentiated cancers detected increased as gastric mucosal atrophy progressed. In addition, open-type atrophy was found in 29 (96.7%) of 30 patients with synchronous multiple gastric cancers and in all 20 patients with metachronous multiple gastric cancers.

Conclusion: Endoscopic evaluation of gastric mucosal atrophy can provide a simple and reliable predictive index for both current and future carcinogenic risk.

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Figures

Fig. 1
Fig. 1
The gastric cancer detection rate in relation to the degree of gastric mucosal atrophy: the rate increased significantly with the progression of gastric mucosal atrophy. All data are percentages and the table displays the p values.
Fig. 2
Fig. 2
The proportion (a) and number (b) of undifferentiated and differentiated gastric cancers in relation to the degree of gastric mucosal atrophy. Undifferentiated cancers were relatively frequent when gastric mucosal atrophy was absent or mild, but differentiated cancers tended to become predominant along with the progression of gastric mucosal atrophy. On the other hand, the number of both differentiated and undifferentiated cancers detected increased as the degree of gastric mucosal atrophy progressed.
Fig. 3
Fig. 3
The number of synchronous multiple gastric cancers in relation to the degree of gastric mucosal atrophy. Of the 30 cases, 29 (96.7%) were of open-type atrophy.
Fig. 4
Fig. 4
The number of metachronous multiple gastric cancers in relation to the degree of gastric mucosal atrophy. All 20 cases had open-type atrophy.
See this image and copyright information in PMC

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