Abstract
BackgroundIn 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.ResultsNewly-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).ConclusionsUniform 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.
Highlights
In Korea, where gastric cancer is highly prevalent, biennial endoscopy is recommended among individuals over 40
This study aimed to identify characteristics of interval gastric neoplasm (IGN) detected during regular screening and risk factors for rapid progression
Patients We retrospectively reviewed medical records of patients who were newly diagnosed with gastric neoplasms, including dysplasia and cancer, during screening endoscopy at a single health-checkup center between January 2004 and May 2016
Summary
In Korea, where gastric cancer is highly prevalent, biennial endoscopy is recommended among individuals over 40. Its incidence and mortality are continuously decreasing, gastric cancer is still the 5th most common cancer and the 3rd leading cause of cancer-related death worldwide. The five-year survival rate of gastric cancer in Korea has considerably increased, which is still an unsatisfactory rate at less than 80% [9]. This can be attributed in part to insufficient endoscopic screening rate of only about 60% [10]. Even despite regular screening, some are still diagnosed with advanced diseases
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