Risk factors for metachronous gastric carcinoma development after endoscopic resection of gastric dysplasia: Retrospective, single-center study

Abstract

AIMTo determine the gastric adenocarcinoma (GAC) occurrence rate and related factors, we evaluated the follow-up results of patients confirmed to have gastric dysplasia after endoscopic resection (ER).METHODSWe retrospectively analyzed the medical records, endoscopic examination records, endoscopic procedure records, and histological records of 667 cases from 641 patients who were followed-up for at least 12 mo, from among 1273 patients who were conformed to have gastric dysplasia after Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) of gastric mucosal lesions between January 2007 and August 2013 at the Chungnam National University Hospital.RESULTSThe mean follow-up period was 33.8 mo, and the median follow-up period was 29 mo (range: 12-87). During the follow-up period, the occurrence of metachronous GAC was 4.0% (27/667). The mean and median interval periods between the occurrence of metachronous GAC and endoscopic treatment of gastric dysplasia were 36.3 and 34 mo, respectively (range: 16-71). The factors related to metachronous GAC occurrence after ER for gastric dysplasia were male sex (5.3% vs 1.0%), open-type atrophic gastritis (9.5% vs 3.4%), intestinal metaplasia (6.8% vs 2.4%), and high-grade dysplasia (HGD; 8.4% vs 3.2%). Among them, male sex [OR: 5.05 (1.18-21.68), P = 0.029], intestinal metaplasia [OR: 2.78 (1.24-6.23), P = 0.013], and HGD [OR: 2.70 (1.16-6.26), P = 0.021] were independent related factors in multivariate analysis. Furthermore, 24 of 27 GAC cases (88.9%) occurred at sites other than the previous resection sites, and 3 (11.1%) occurred at the same site as the previous resection site.CONCLUSIONMale sex, intestinal metaplasia, and HGD were significantly related to the occurrence of metachronous GAC after ER of gastric dysplasia, and most GACs occurred at sites other than the previous resection sites.

Risk of metachronous gastric neoplasm occurrence during intermediate-term follow-up period after endoscopic submucosal dissection for gastric dysplasia

“…Although the reported progression rates varied in different studies, patients with HGD had higher rates of progression to invasive carcinoma (10%-68.8%) than those with LGD (2.8-11.5%) [3][4][5][6][7] . A recent study reported that HGD was a significant risk factor for the development of metachronous gastric cancer after ESD of gastric dysplasia (odds ratio, 2.74; P = 0.023 vs. LGD) 12 . Similarly, in the present study, the risks of MGNs (HR, 1.45; P = 0.425), and metachronous HGD or gastric cancer (HR, 2.42; P = 0.214) were increased in the HGD group compared with the LGD group; however, there were no statistical significances between the two groups.…”

“…Thus, long-term surveillance endoscopy after ER of gastric dysplasia should focus on high-risk patients to increase cost-effectiveness. Risk factors associated with metachronous neoplasm or EGC after ER for gastric dysplasia were male sex 12 , old age 14,16 , open-type atrophic gastritis 15 , presence of intestinal metaplasia 12,14 , and HGD 12 . However, the reported risk factors were numerous and inconsistent among different studies.…”

“…Guidelines recommended endoscopic resection (ER) in patients with gastric dysplasia due to the increased probability of coexisting invasive carcinoma or the risk of progression [9][10][11] . Similar to early gastric cancer (EGC) patients who underwent ER, metachronous gastric neoplasms occurred in 12.1-14.6% patients with gastric dysplasia [12][13][14] . Thus, long-term regular follow-up might be needed after ER of gastric dysplasia.…”

Clinical Implications of Synchronous and Metachronous Multiple Gastric Tumors after Endoscopic Resection of Gastric Neoplasms

“…For diagnosis of gastric dysplasia, specimens obtained by endoscopic biopsy are not representative of the entire lesion, and histological discrepancies have been reported between biopsy specimens and resected ones [ 1 ]. Therefore, endoscopic resection (ER) is recommended for gastric dysplasia, not only for removal of the lesion but also for its exact diagnosis [ 2 ]. As gastric dysplasia poses a risk of metachronous gastric cancer, surveillance after ER is important.…”

“…Interestingly, most of the the newly detected lesions showed the same endoscopic and histopathological types as those of the primary lesions in this study. However, a previous study reported that most metachronous gastric adenocarcinomas occurred at sites other than the previous resection sites [ 2 ]. Therefore, more studies are necessary to clarify the findings of this study.…”