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. 2021 Mar 2;21(1):218.
doi: 10.1186/s12885-021-07929-y.

Characteristics of interval gastric neoplasms detected within two years after negative screening endoscopy among Koreans

Joo Hyun Lim  1 , Ji Hyun Song #  2 , Su Jin Chung #  3 , Goh Eun Chung  1 , Joo Sung Kim  1   4
Affiliations

Characteristics of interval gastric neoplasms detected within two years after negative screening endoscopy among Koreans

Joo Hyun Lim et al. BMC Cancer. .

Abstract

Background: In Korea, where gastric cancer is highly prevalent, biennial endoscopy is recommended among individuals over 40. Even under regular screening, some are still diagnosed at advanced stages. We aimed to identify characteristics of interval gastric neoplasms (IGNs) with rapid progression.

Results: Newly-diagnosed gastric neoplasms detected in screening endoscopy between January 2004 and May 2016 were reviewed. Among them, those who had previous endoscopy within 2 years were enrolled. Endoscopic findings, family history of gastric cancer, smoking, and H. pylori status were analysed. Totally, 297 IGN cases were enrolled. Among them, 246 were endoscopically treatable IGN (ET-IGN) and 51 were endoscopically untreatable IGNs (EUT-IGN) by the expanded criteria for endoscopic submucosal dissection. Among EUT-IGNs, 78% were undifferentiated cancers (40/51) and 33% showed submucosal invasion (13/40). They were median 2.0 cm in size and more commonly located in the proximal stomach than ET-IGNs (70.6% vs. 41.9%, p < 0.001). EUT-IGN was independently related with age < 60 (OR, 2.09; 95%CI, 1.03-4.26, p = 0.042), H. pylori (OR, 2.81; 95%CI, 1.20-6.63, p = 0.018), and absent/mild gastric atrophy (OR, 2.67; 95%CI, 1.25-5.72, p = 0.011). Overall and disease-specific survival were not significantly different between the two groups, however EUT-IGN tended to have short disease-specific survival (overall survival, p = 0.143; disease-specific survival, p = 0.083).

Conclusions: Uniform screening endoscopy with two-year interval seems not enough for rapid-growing gastric neoplasms, such as undifferentiated cancers. They tended to develop in adults younger than 60 with H. pylori infection without severe gastric atrophy. More meticulous screening, especially for proximal lesions is warranted for adults younger than 60 with H. pylori infection before development of gastric atrophy.

Keywords: Atrophic gastritis; Gastric neoplasm; H. pylori; Screening endoscopy; Undifferentiated histology.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study flow chart showing patient enrollment
Fig. 2
Fig. 2
Odds ratios and 95% confidence intervals of potential risk factors for endoscopically untreatable-gastric neoplasm. BMI, body mass index; H. pylori, Helicobacter pylori
Fig. 3
Fig. 3
Kaplan-Meier curves comparing ET-IGN and EUT-IGN: (a) Overall survival; (b) Gastric cancer-specific survival. ET-IGN, endoscopically treatable-gastric neoplasm; EUT-IGN, endoscopically untreatable-gastric neoplasm
See this image and copyright information in PMC

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