Incidence and Predictors of Gastric Neoplastic Lesions in Corpus-Restricted Atrophic Gastritis: A Single-Center Cohort Study

Abstract

INTRODUCTION:Corpus-restricted atrophic gastritis is a chronic inflammatory disorder leading to possible development of type 1 neuroendocrine tumors (T1gNET), intraepithelial neoplasia (IEN), and gastric cancer (GC). We aimed to assess occurrence and predictors of gastric neoplastic lesions in patients with corpus-restricted atrophic gastritis at long-term follow-up.METHODS:A prospective single-center cohort of patients with corpus-restricted atrophic gastritis adhering to endoscopic-histological surveillance was considered. Follow-up gastroscopies were scheduled according to the management of epithelial precancerous conditions and lesions of the stomach guidelines. In case of new/worsening of known symptoms, gastroscopy was anticipated. Cox regression analyses and Kaplan-Meier survival curves were obtained.RESULTS:Two hundred seventy-five patients with corpus-restricted atrophic gastritis (72.0% female, median age 61 [23–84] years) were included. At a median follow-up of 5 (1–17) years, the annual incidence rate person-year was 0.5%, 0.6%, 2.8%, and 3.9% for GC/high-grade IEN, low-grade IEN, T1gNET, and all gastric neoplastic lesions, respectively. All patients showed at baseline operative link for gastritis assessment (OLGA)-2, except 2 low-grade (LG) IEN patients and 1 T1gNET patient with OLGA-1. Age older than 60 years (hazard ratio [HR] 4.7), intestinal metaplasia without pseudopyloric metaplasia (HR 4.3), and pernicious anemia (HR 4.3) were associated with higher risk for GC/HG-IEN or LG-IEN development and shorter mean survival time for progression (13.4, 13.2, and 11.1, respectively, vs 14.7 years, P = 0.01). Pernicious anemia was an independent risk factor for T1gNET (HR 2.2) and associated with a shorter mean survival time for progression (11.7 vs 13.6 years, P = 0.04) as well as severe corpus atrophy (12.8 vs 13.6 years, P = 0.03).DISCUSSION:Patients with corpus-restricted atrophic gastritis are at increased risk for GC and T1gNET despite low-risk OLGA scores, and those aged older than 60 years with corpus intestinal metaplasia or pernicious anemia seem to display a high-risk scenario.

Long-Term Natural History of Autoimmune Gastritis: Results From a Prospective Monocentric Series

“…The strengths of this study are the long-term prospective nature, with a median disease history of 18 years, the comprehensive laboratory, clinical, and histopathological characterization, and the evaluation of the whole spectrum of AIG, including, for the first time, potential and seronegative AIG, thus reflecting the real-life setting. Under this perspective, our series is very different, and our results are complementary, compared with the recently published studies looking at the natural history of AIG (15,20). Indeed, several novel results have emerged from this study.…”

“…Essentially, our results are similar to those by Rugge et al (15), who had, however, only included PCA-positive and H. pylori-negative patients with AIG, without providing a clinical characterization, and hence, the studied population was different and highly selected. Instead, the low (annual incidence rate of overt cancer of 0.5%)-but yet present-risk of developing gastric epithelial neoplasia in the study by Dilaghi et al (20) may reflect the more heterogeneous population included, purposely enrolling also patients with a known history of H. pylori infection and not necessarily AIG only. Notably, in that study, most patients developing cancer also had pernicious anemia, possibly reflecting a more severe and more neglected disease, burdened by a greater diagnostic delay.…”

“…We have confirmed (6), on a longer follow-up time, that AIG is a steadily progressive disease with no cases of regression of atrophy. As already mentioned, the true incidence of overt neoplasia, especially epithelial, is still a matter of debate and has recently raised a stimulating debate among experts in the field after the release of novel data about the incidence of neoplastic lesions in AIG or in corpus-restricted atrophy (15,20). By applying a real-world study, certainly focusing on AIG, regardless of the previous known or unknown history of H. pylori (though never active infection in all cases) and including PCA-negative patients, no cases of adenocarcinoma were noticed, while the risk of developing NET is quite high, especially in stage 3 patients.…”

“…Indeed, this figure may not reflect that of a real-life setting, in which a history of H. pylori infection cannot always be ruled out, and additional risk factors may have a role. In fact, when applying less stringent criteria, patients with corpus-restricted gastritis were found to have an annual cumulative incidence rate of any epithelial dysplasia/gastric adenocarcinoma of 1.1% (20).…”

Diagnosis and Treatment Design Strategy for Gastric Neoplasia

“…In the article by Dilaghi et al (1), the authors performed a single-center cohort study to evaluate the incidence of gastric neoplasia occurring in the setting of atrophic gastritis. The authors show convincing data that in patients with corpus-associated atrophic gastritis that gastric adenocarcinoma and gastric neuroendocrine tumors occur predominantly in patients older than 60 years.…”