Metachronous lesions after gastric endoscopic submucosal dissection: first assessment of the FAMISH prediction score

Abstract

Background and study aim: Surveillance after gastric endoscopic submucosal dissection (ESD) is recommended for all patients due to the persistent risk of metachronous gastric lesions (MGLs). We aimed to develop and validate a prediction score to estimate MGL risk after ESD for early neoplastic gastric lesions, to define an individualized and cost saving approach. Patients and methods: Clinical predictors and a risk score were derived from meta-analysis data. A retrospective, single centre, cohort study including patients with >3 years standardized surveillance after ESD was conducted for score validation. Predictive accuracy of the score by the receiver operating characteristic curve was assessed and cumulative probabilities of MGL were estimated. Results: The risk score (0-9 points) included 6 clinical predictors (scored 0-3): positive family history of gastric cancer, older age, male gender, corpus intestinal metaplasia, synchronous gastric lesions and persistent Helicobacter pylori infection. Study population included 263 patients; the MGL rate was 16%. The score diagnostic accuracy for predicting MGL at 3 years of follow-up as measured by the AUC was 0.704 (95% CI 0.603-0.806). At 3 years and a cut-off <2, it achieved maximal sensitivity and negative predictive value; 15% patients could be assigned to a low-risk group, in which the progression to MGL was significantly lower than for the high-risk group (p=0.037). Conclusion: The FAMISH score might be a concise and useful tool, accurately identifying patients with low-to-intermediate risk for MGL at 3 years of follow-up, who might expand the surveillance interval to reduce the burden of care.

External validation of the FAMISH predicting score for early gastric cancer with endoscopic submucosal dissection

“…Based on the FAMISH predicting score, the patients were stratified into three risk groups. Notably, the cutoff values for stratification were quite different from those proposed by Rei et al [17], which may be explained by the different patient populations. We also found that MGLs detected in the high-risk group were less likely to be cured with ESD than those detected in the other risk groups, highlighting the need for more intensive surveillance in this subpopulation.…”

“…The FAMISH predicting score was first developed by Rei et al based on meta-analysis data and was validated in a small cohort of 263 patients who underwent ESD for primary gastric lesions [17]. This score included six clinical predictors: positive family history of gastric cancer (1 point), aged ≥65 years (1 point), male sex (1 point), corpus IM, synchronous gastric lesions (3 points), and persistent H. pylori infection (2 points), with points for each predictor varying from 0 to 3 and a composite score of 0–9.…”

“…A recent meta-analysis suggested that older age, male sex, family history, synchronous lesions, severe gastric mucosal atrophy, intestinal metaplasia (IM) in the corpus, persistent H. pylori infection, and a lower pepsinogen I/II ratio were significantly associated with MGL [16]. Based on these findings, Rei et al developed a novel tool, the FAMISH predicting score, to estimate the risk of developing MGLs after ESD in a European population [17].…”