Risk and prognostic factors of invasive gastric cancer detection during surveillance endoscopy: Multi‐institutional cross‐sectional study

Abstract

Objectives Esophagogastroduodenoscopy (EGD) is important for the detection of curable gastric cancer (GC). However, there are no appropriate surveillance data during routine endoscopic inspections. This study aimed to clarify the risk factors of pT1b or deeper GC detection during surveillance endoscopy. Methods This was a retrospective, multicenter, cross‐sectional study conducted in 15 Japanese hospitals. We retrospectively analyzed patients with GC who had previously undergone surveillance endoscopy at each institution from January 2014 to March 2020. Patients who had undergone gastrectomy, non‐infection of Helicobacter pylori (Hp), and those with intervals <3 months or >10 years from a previous endoscopy were excluded. Results In total, 1085 patients with GCs detected during surveillance endoscopy were enrolled. The multivariate logistic analysis revealed that current Hp infection (odds ratio [OR] 2.18; 95% confidence interval [CI] 1.50–3.16) and a surveillance interval of >1.5 years (OR 1.96; 95% CI 1.35–2.84) were independent risk factors for pT1b or deeper GC. The 5‐year disease‐specific survival (5y‐DSS) rate of GC was significantly lower in patients with surveillance interval of >1.5 years than in those with surveillance interval of ≤1.5 years (93.7% vs. 98.3%, P < 0.001). Similarly, the 5y‐DSS rate of GC was significantly lower in patients with active Hp infection than in those without (93.7% vs. 99.4%, P < 0.001). Conclusion In this study, a surveillance interval of >1.5 years and current Hp infection were independent risk factors for detecting pT1b or deeper GC. Additionally, these factors were poor prognostic factors of the detected GC during surveillance endoscopy.

Appropriate interval of surveillance endoscopy for early detection of gastric cancer

“…reported that more than 95% of patients with metachronous gastric cancers could be treated by curative endoscopic resection, even if the interval between surveillance endoscopies was 1.0 year. Conversely, Yasuda et al 1 . reported that the proportion of T1b or deeper gastric cancers increased with increasing surveillance intervals in the medium‐risk group.…”

“…The risk of gastric cancer was 1.7 (95% confidence interval [CI] 0.8–19.2) for moderate atrophy and 4.9 (95% CI 2.8–19.2) for severe atrophy when no to mild atrophy was set as 1 5 . In the cohort of Yasuda et al ., 1 90% of patients had open‐type atrophy, who may have had a relatively high risk of gastric cancer. Based on their results, a surveillance interval of ≤1.5 years may be recommended for those with severe atrophy to reduce the risk of surgical resection for gastric cancer 1 .…”

“…Yasuda et al 1 investigated the frequency of pT1b or deeper gastric cancers and the prognosis at each surveillance interval in a retrospective, multicenter, cross-sectional study. They defined patients with a history of endoscopic resection for gastric cancer as a high-risk group, those with past or existing H. pylori infection without history of gastric cancer, as a medium-risk group, and those with a history of gastric surgery or H. pylori uninfected, as a low-risk group.…”

“…Based on their results, a surveillance interval of ≤1.5 years may be recommended for those with severe atrophy to reduce the risk of surgical resection for gastric cancer. 1 Comparing the risk of gastric cancer in the initial 10 years and the second 10 years after eradication, Take et al reported that with a longer observation period, the risk of developing diffusetype gastric cancer, such as poorly differentiated adenocarcinoma and signet-ring cell carcinoma, increased in patients with mild to moderate gastric atrophy at the time of eradication. 6 These data suggest that, even if gastric mucosal atrophy is mild or moderate after eradication, the risk of gastric cancer is prevalent in the long term, suggesting the need for continued surveillance.…”

“…Yasuda et al 1 . investigated the frequency of pT1b or deeper gastric cancers and the prognosis at each surveillance interval in a retrospective, multicenter, cross‐sectional study.…”