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

Lee, Ji Young; Gong, Eun Jeong; Chung, Eun Ju; Park, Hye Won; Bae, Suh Eun; Kim, Eun Hee; Kim, Jaeil; Suh, Yoon Seok; Kim, Tae Hyup; Chang, Hyo Won; Song, Ho June; Choe, Jaewon; Jung, Hwoon‐Yong

doi:10.5009/gnl17033

Cited by 41 publications

(32 citation statements)

References 32 publications

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“…The baseline age at H. pylori eradication was less in patients with mild or moderate than with severe gastric atrophy in our cohort, but the risk did not change in case of intestinal-type cancer through the follow-up period up to 21 years regardless of the grade of baseline mucosal atrophy, a finding suggesting that factors other than aging are involved. Early gastric cancers of diffuse type are often superficial and flat, with only discoloration and are difficult to recognize endoscopically [23]. During the past decades, endoscopy equipment has improved greatly, and techniques such as magnifying endoscopy with narrow band imaging have improved the ability to detect early diffuse-type gastric cancer [24].…”

Section: Discussionmentioning

confidence: 99%

Risk of gastric cancer in the second decade of follow-up after Helicobacter pylori eradication

et al. 2019

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Background and aims Eradication of Helicobacter pylori reduces the risk of gastric cancer. In this study, we investigated the risk beyond 10 years after eradication of H. pylori. Methods We conducted a retrospective cohort study of 2737 patients who had yearly endoscopic follow-up after cure of H. pylori infection. For comparison of gastric cancer risk in the second decade of follow-up with that in the first decade, we calculated standardized incidence ratios (SIRs) by dividing the number of observed cases of gastric cancer in the second decade of follow-up by that of expected cases which was estimated using the incidence rate ratio of age in the first decade. Results During the follow-up for as long as 21.4 years (mean 7.1 years), gastric cancer developed in 68 patients (0.35% per year). The SIRs for diffuse-type gastric cancer was infinity (0 expected case and 4 observed cases) in patients with mild gastric mucosal atrophy and 10.9 (95% confidence interval 4.53-26.1) with moderate atrophy, whereas no significant increase of SIRs was observed in intestinal-type cancer regardless of the grade of baseline gastric atrophy or in diffuse-type cancer in patients with severe atrophy even though who had the highest risk. Conclusions The longer the follow-up, the greater the risk of developing diffuse-type gastric cancer becomes in patients with mild-to-moderate gastric atrophy at baseline. Endoscopic surveillance should be continued beyond 10 years after cure of H. pylori irrespective of the severity of gastric atrophy.

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Section: Discussionmentioning

confidence: 99%

Risk of gastric cancer in the second decade of follow-up after Helicobacter pylori eradication

et al. 2019

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“…The calibration range of this immunoassay is 0.4–8.0 U/mL, with the Hp-IgG titer classified as follows: negative, 0–1.0 U/mL; positive, 1.1–7.9 U/mL; and high positive, ≥8.0 U/mL. We divided the patients in the H. pylori-positive group into two approximately equal subgroups according to a cutoff value chosen to ensure the same number of cases for each subgroup: the low-positive group (1.1–4.2 U/mL, n = 288) and the mid-positive group (4.3–7.9 U/mL, n = 290) ( Fig 1 )[ 9 , 12 ].…”

Section: Methodsmentioning

confidence: 99%

“…pylori infection status, with the proportion of diffuse-type GC being higher in patients with current infection than in those with past infection [ 8 ]. In addition, several studies including our previous study have suggested that subjects with a low Hp-IgG titer are at high risk for intestinal-type GC, whereas those with a high Hp-IgG titer are at increased risk for diffuse-type GC [ 9 – 12 ]. Chronological change in Hp-IgG titers which decrease with the progression of gastric mucosal atrophy may be attributable to the association between past infection or low Hp-IgG titer and intestinal-type GC [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Characteristics of non-cardia gastric cancer with a high serum anti-Helicobacter pylori IgG titer and its association with diffuse-type histology

et al. 2018

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BackgroundData on implications of a high positive titer of serum anti-Helicobacter pylori antibody on gastric cancer (GC) is limited. This study aimed to investigate the characteristics of GC with a high serum anti-H. pylori IgG (Hp-IgG) titer, and its association with diffuse-type GC.MethodsWe analyzed clinical and histological characteristics of 917 non-cardia GC patients who underwent gastrectomy. H. pylori infection was determined serologically by measuring Hp-IgG titer with immunoassay. Seropositive patients were divided into three groups (low-positive, mid-positive, and high-positive) according to the Hp-IgG titer value. Tumors were classified according to the Lauren criteria as diffuse or intestinal types.ResultsThe median age of the patients was 59.0 years, and 33.8% were female. The patents were grouped as follows: seronegative, 188 (20.5%); low-positive, 288 (31.4%); mid-positive, 290 (31.6%); and high-positive 151 (16.5%). The high-positive group was significantly younger (median age, 55.0 years), with a higher proportion of female (45.0%) and non-smokers (58.9%). The proportion of diffuse-type GC increased in the order low-, mid-, and high-positive groups (p<0.001). In univariate analysis, the factors associated with diffuse-type GC were younger age, female sex, non-smokers, and a high-positive Hp-IgG titer. Younger age, female sex, and non-smokers remained significant on multivariate analysis whereas the high-positive Hp-IgG titer showed only a tendency toward the association (p = 0.078).ConclusionsNon-cardia GC patients with a high Hp-IgG titer have distinct clinicopathologic characteristics. A high-positive Hp-IgG titer should be interpreted together with patients’ age, sex, and smoking status.

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“…Second, mixed‐type EGC can be simply classified as predominantly differentiated (MD) or predominantly undifferentiated (MU) types. Various studies have investigated the risk of LNM in these two types of EGC . Mita and Shimoda compared the clinicopathological features of submucosal differentiated EGC with and without LNM, and found that the rate of LNM in mixed EGC was higher, which was further identified in the multivariate analysis .…”

Section: Endoscopic Resection Indications For Egcmentioning

confidence: 99%

Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review

Zhang

Gao

et al. 2019

J of Digest Diseases

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With the wide application of endoscopic resection for early gastric cancer (EGC) by not only Asian endoscopists but also those from Western countries, reviews on standardized treatment processes before and after endoscopic resection are nevertheless lacking. In this article we provide a narrative review of studies on the selection of appropriate EGC for endoscopic resection and the follow-up strategies for those with histologically confirmed EGC after endoscopic resection. EGC should be comprehensively assessed before endoscopic resection, including its exact margin, invasive depth and risk of lymph node metastasis (LNM). While the curative resection status of EGC may be evaluated after endoscopic resection based on the newly developed eCura system, although this needs to be further verified. Surveillance with endoscopy and computed tomography scan is necessary for patients with an EGC level A or B. An additional endoscopic resection is recommended for patients with a level-C1 EGC. For patients with a level-C2 EGC, close follow-up is suggested for low-risk tumors of level C2 and additional surgery for those at high risks. Further postoperative strategy is suggested based on comprehensive assessment of the risk of LNM, patient's quality of life and wishes. K E Y W O R D Scurative resection, early gastric cancer, eCura system, endoscopy, gastric neoplasms, surveillance

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

Cited by 41 publications

References 32 publications

Risk of gastric cancer in the second decade of follow-up after Helicobacter pylori eradication

Risk of gastric cancer in the second decade of follow-up after Helicobacter pylori eradication

Characteristics of non-cardia gastric cancer with a high serum anti-Helicobacter pylori IgG titer and its association with diffuse-type histology

Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review

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