Atrophic and Metaplastic Progression in the Background Mucosa of Patients with Gastric Adenoma

Abstract

BackgroundIn patients with adenoma, assessing premalignant changes in the surrounding mucosa is important for surveillance. This study evaluated atrophic and metaplastic progression in the background mucosa of adenoma or early gastric cancer (EGC) cases.MethodsAmong 146 consecutive patients who underwent endoscopic resection for intestinal-type gastric neoplasia, the adenoma group included 56 patients with low-grade dysplasia and the ECG group included 90 patients with high-grade dysplasia or invasive carcinoma. For histology, 3 paired biopsies were obtained from the antrum, corpus lesser curvature (CLC), and corpus greater curvature (CGC). Serological atrophy was determined based on pepsinogen A (PGA), progastricsin (PGC), gastrin-17, and total ghrelin levels. Topographic progression of atrophy and/or metaplasia was staged using the operative link on gastritis assessment (OLGA) and operative link on gastric intestinal metaplasia assessment (OLGIM) systems.ResultsRates of moderate-to-marked histological atrophy/metaplasia in patients with adenoma were 52.7%/78.2% at the antrum (vs. 58.8%/76.4% in EGC group), 63.5%/75.0% at the CLC (vs. 60.2%/69.7% in EGC group), and 10.9%/17.9% at the CGC (vs. 5.6%/7.8% in EGC group). Serological atrophy indicated by PGA and PGC occurred in 23.2% and 15.6% of cases in the adenoma and ECG groups, respectively (p = 0.25). Mean serum gastrin-17 concentrations of the adenoma group and EGC group were 10.4 and 9.0 pmol/L, respectively (p = 0.54). Mean serum total ghrelin levels were 216.6 and 209.5 pg/mL, respectively (p = 0.71). Additionally, between group rates of stage III–IV OLGA and OLGIM were similar (25.9% vs. 25.0%, p = 0.90; 41.8% vs. 44.9%, p = 0.71, respectively).ConclusionsAtrophic and metaplastic progression is extensive and severe in gastric adenoma patients. A surveillance strategy for metachronous tumors should be applied similarly for patients with adenoma or EGC.

Clinical features of gastric adenoma detected within 3 years after negative screening endoscopy in Korea

“…In the present study, intestinal metaplasia of the gastric mucosa was associated with a 3-fold increased risk of missed adenoma. In accordance with the findings of a recent South Korean study [ 16 ], patients with biopsy-proven intestinal metaplasia in the background or surrounding gastric mucosa were at a higher risk of gastric adenoma. Severe metaplastic progression was observed in 146 patients with endoscopically resected gastric adenoma or early gastric cancer.…”

Gastrin/CCK-B Receptor Signaling Promotes Cell Invasion and Metastasis by Upregulating MMP-2 and VEGF Expression in Gastric Cancer

“…The pathological analysis confirmed that the histologic changes observed in GAS-KO mice were similar to the precursor lesions progressing to gastric cancer, particularly atrophic gastritis, in human subjects. Atrophic gastritis was often present in the surrounding mucosa adjacent to gastric cancer [32]. Our finding in human subjects was similar to GAS-KO mice.…”

The Characteristics and Prognosis of Diffuse-Type Early Gastric Cancer Diagnosed during Health Check-Ups

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