Endoscopic gastric cancer screening and surveillance in high-risk groups.
Endoscopic gastric cancer screening and surveillance in high-risk groups.
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DOI：
10.5946/ce.2014.47.6.497
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发表时间：
2014-11
影响因子：
2.5
通讯作者：
Choi IJ
中科院分区：
文献类型：
--
作者：
Choi IJ
胃癌仍然是世界范围内的主要癌症问题，由于人口迅速老龄化，未来的发病率可能会增加。在胃癌发病率高的韩国和日本，正在进行基于人群的筛查，似乎可以有效降低胃癌死亡率。然而，这种战略很难在发病率低或资源有限的国家实施。因此，筛查策略应针对高危人群亚群。胃癌平均停留时间较长，早期预后良好。在一般人群中，韩国每2年进行一次筛查似乎对早期诊断有效。根据欧洲和日本的建议，对于萎缩性胃炎或肠化生患者，建议每隔1 - 3年进行监测。散发性胃癌家族成员的筛查间隔尚未得到充分评估，但建议对遗传性弥漫性胃癌家族成员进行1年的筛查间隔。经内镜切除的胃癌患者是高危人群，间隔1年的监测可早期发现多数异时性胃癌。未来的内镜胃癌监测策略应以风险分层评估为指导，并需要进一步细化最佳监测间隔。
Gastric cancer remains a major cancer problem world-wide and future incidence will likely increase due to rapidly aging population demographics. Population-based screening is being undertaken in Korea and Japan, where gastric cancer incidence rates are high, and seems to be effective in reducing mortality from gastric cancer. However, such strategies are difficult to implement in countries with a low incidence or limited resources. Thus, screening strategies should be directed towards high-risk population subgroups. Gastric cancer has a relatively long mean sojourn time, and prognosis of early-stage disease is excellent. In general population, screening at 2-year interval in Korea seems to be effective for early-stage diagnosis. In subjects with atrophic gastritis or intestinal metaplasia, surveillance is recommended at 1 to 3 years intervals according to European and Japanese recommendation. Screening intervals for family members with sporadic gastric cancer has not yet been adequately evaluated, but 1-year interval is recommended for hereditary diffuse gastric cancer family-members. Gastric cancer patients treated by endoscopic resection are the highest-risk group, and 1-year interval surveillance can detect most metachronous gastric cancers at an early stage. Future gastric cancer surveillance strategies using endoscopy should be guided by risk-stratification assessment, and further refinement of optimal surveillance intervals is needed.