Surveillance of premalignant gastric cardia lesions: A population-based prospective cohort study in China
Surveillance of premalignant gastric cardia lesions: A population-based prospective cohort study in China
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DOI：
10.1002/ijc.33720
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发表时间：
2021-07-07
影响因子：
6.4
通讯作者：
Wei, Wenqiang
中科院分区：
文献类型：
--
作者：
Gu, Jianhua;Xie, Shuanghua;Wei, Wenqiang
在我们的研究中，我们旨在评估具有不同组织学贲门病变的患者的贲门腺癌（GCA）的长期风险，为中国GCA筛查的未来指南提供信息。我们在2005年至2009年期间接受上消化道内镜筛查的9740例受试者中进行了一项基于人群的前瞻性研究，并随访至2017年12月。通过基线组织学诊断计算GCA的累积发病率和死亡率，并通过考克斯比例风险模型分析总体和年龄及性别的风险比（HR）。在平均10年的随访中，我们发现了123例新的GCA病例（1.26%）和31例GCA死亡（0.32%）。贲门癌的年龄标化发病率和死亡率分别为128.71/10万和35.69/10万人年，贲门高度异型增生（CHGD）、贲门低度异型增生（CLGD）和萎缩性心脏炎（AC）/贲门肠上皮化生（CIM）的累积发病率分别为25%、3.05%和1.58%。GCA的进展率和癌症风险随着Correa级联中的每一步而单调增加。年龄在50至69岁之间的人GCA发病率是40至49岁的人的4.4倍。CLGD患者的3年GCA发生率显著高于正常组，而AC/CIM患者在3年随访期间的GCA风险相当，但在5年间隔时的风险较高。我们的研究结果表明，GCA筛查的开始年龄推迟到50岁，CHGD患者立即治疗，CLGD患者的监测间隔为3年，AC/CIM患者的监测间隔延长为5年。
In our study, we aimed to assess the long-term risk of gastric cardia adenocarcinoma (GCA) for patients with different histological cardia lesions to inform future guidelines for GCA screening in China. We conducted a population-based prospective study among 9740 subjects who underwent upper endoscopy screening during 2005 to 2009 and followed until December 2017. Cumulative incidence and mortality rates of GCA were calculated by the baseline histological diagnoses, and the hazard ratios (HRs), overall and by age and sex, were analyzed by Cox proportional hazards models. During a median follow-up of 10 years, we identified 123 new GCA cases (1.26%) and 31 GCA deaths (0.32%). The age-standardized incidence and mortality rates of GCA were 128.71/100 000 and 35.69/100 000 person-years, and cumulative incidence rate in patients with cardia high-grade dysplasia (CHGD), cardia low-grade dysplasia (CLGD) and atrophic carditis (AC)/cardia intestinal metaplasia (CIM) was 25%, 3.05% and 1.58%, respectively. The progression rate and cancer risk of GCA increased monotonically with each step in Correa's cascade. Individuals aged 50 to 69 years had 4.4 times higher GCA incidence than those aged 40 to 49 years. Patients with CLGD had a significantly higher 3-year GCA incidence than the normal group, while patients with AC/CIM had a comparable GCA risk during 3-year follow-up but a higher risk at 5-year intervals. Our results suggested a postponed starting age of 50 years for GCA screening, immediate treatment for patients with CHGD, a 3-year surveillance interval for patients with CLGD, and a lengthened surveillance interval of 5 years for patients with AC/CIM.