Survival Outcome Associated with the Screening Interval for Gastric Cancer in Korea

Abstract

Background/Aims: Early gastric cancer (EGC) can be treated by endoscopic resection, which results in an excellent prognosis. Optimal screening intervals considering risk factors for gastric cancer have not been established. The aim of this study was to determine the maximum gastric cancer screening interval in terms of long-term survival. Methods: Curative resection was performed in 561 patients with gastric cancer who had completed a questionnaire on their previous history of screening tests and risk factors. The association between EGC detection rate and previous screening history was evaluated, and 5-year disease-free survival rates were compared between various screening intervals. Results: Multivariate analysis showed that intestinal metaplasia [hazard ratio (HR) 9.690, 95% confidence interval (CI) 5.896–15.927] and previous screening history (HR 0.077, 95% CI 0.048–0.125) were independent factors associated with advanced gastric cancer. In patients without intestinal metaplasia, there was no significant difference in the extent of gastric cancer progression and the 5-year disease-free survival rate between groups with screening intervals of less than 3 years. In patients with intestinal metaplasia, the cutoff screening interval for detection of EGC and disease-free survival was 2 years. Conclusion: The optimum screening interval for disease-free survival for gastric cancer in a normal population is 3 years, but a screening interval of 2 years should be used for patients with intestinal metaplasia in Korea.

Effect of annual endoscopic screening on clinicopathologic characteristics and treatment modality of gastric cancer in a high‐incidence region of Korea

“…An approach to risk stratification and thereby a stepwise increasing the frequency of screening endoscopy thus appears to be more suitable. Our data confirmed the effectiveness of periodic endoscopic screening within 2–3 years on improvement in the overall survival,19, 32 while annual endoscopic screening did not increase the GC‐related survival rates further in comparison with biennial screening. The reason could be attributable to the localized and regional diseases in most cases of both annual and biennial screening groups, which yielded an excellent disease‐free survival as well as overall survival following curative treatment not only by surgery but also by a less invasive endoscopic resection.…”

“…Although a debate over the cost and benefit of the screening is ongoing, interest has shifted to determining the preferred strategy and discerning the most effective ways of implementing screening in high‐incidence countries of GC 12, 17, 25. Most endoscopic screening studies have reported that 2‐ to 3‐year intervals are sufficient to detect early stage GC,11, 12, 19–21, 32 while 4‐ to 5‐year intervals did not affect the mortality in a high‐risk Chinese cohort 33. Our large proportion of EGC (90.7%) within 2 years after an earlier negative endoscopy is well within the upper range of preceding reports (87.2–96%) and reinforces current recommendations of a 2‐year interval for population‐based screening in high‐incidence countries 20, 21.…”

The prevalence of histologic atrophy and intestinal metaplasia in the corpus has decreased over 15 years in females in the Korean population

“…In particular, H pylori is associated with both intestinal and diffuse types of GC, and through damage to epithelial cells, H pylori‐ associated chronic active gastritis is known to be a major risk factor for GC . Because the incidence of GC is high in patients diagnosed with IM, GC screening is recommended . In Korea, where the incidence of GC is the highest in the world, endoscopic screening for early GC is recommended every 2 years for adults over 40 years old.…”

Does the interval of screening endoscopy affect survival in gastric cancer patients?

“…[15,16,20,29–31] According to our results, stage-adjusted overall survival rates were not significantly different among the screening interval groups. Thus, these results may suggest that the survival benefit of screening endoscopy was achieved by the early detection of gastric cancer.…”