Severity of gastric intestinal metaplasia predicts the risk of gastric cancer: a prospective multicentre cohort study (GCEP)

Author:

Lee Jonathan W JORCID,Zhu FengORCID,Srivastava Supriya,Tsao Stephen KK,Khor Christopher,Ho Khek YuORCID,Fock Kwong Ming,Lim Wee Chian,Ang Tiing Leong,Chow Wan ChengORCID,So Jimmy Bok Yan,Koh Calvin JORCID,Chua Shijia Joy,Wong Andrew S Y,Rao Jaideepraj,Lim Lee Guan,Ling Khoon Lin,Chia Chung-King,Ooi Choon JinORCID,Rajnakova Andrea,Yap Wai Ming,Salto-Tellez Manuel,Ho Bow,Soong Richie,Chia Kee Seng,Teo Yik Ying,Teh Ming,Yeoh Khay-GuanORCID

Abstract

ObjectiveTo investigate the incidence of gastric cancer (GC) attributed to gastric intestinal metaplasia (IM), and validate the Operative Link on Gastric Intestinal Metaplasia (OLGIM) for targeted endoscopic surveillance in regions with low-intermediate incidence of GC.MethodsA prospective, longitudinal and multicentre study was carried out in Singapore. The study participants comprised 2980 patients undergoing screening gastroscopy with standardised gastric mucosal sampling, from January 2004 and December 2010, with scheduled surveillance endoscopies at year 3 and 5. Participants were also matched against the National Registry of Diseases Office for missed diagnoses of early gastric neoplasia (EGN).ResultsThere were 21 participants diagnosed with EGN. IM was a significant risk factor for EGN (adjusted-HR 5.36; 95% CI 1.51 to 19.0; p<0.01). The age-adjusted EGN incidence rates for patients with and without IM were 133.9 and 12.5 per 100 000 person-years. Participants with OLGIM stages III–IV were at greatest risk (adjusted-HR 20.7; 95% CI 5.04 to 85.6; p<0.01). More than half of the EGNs (n=4/7) attributed to baseline OLGIM III–IV developed within 2 years (range: 12.7–44.8 months). Serum trefoil factor 3 distinguishes (Area Under the Receiver Operating Characteristics 0.749) patients with OLGIM III–IV if they are negative for H. pylori. Participants with OLGIM II were also at significant risk of EGN (adjusted-HR 7.34; 95% CI 1.60 to 33.7; p=0.02). A significant smoking history further increases the risk of EGN among patients with OLGIM stages II–IV.ConclusionsWe suggest a risk-stratified approach and recommend that high-risk patients (OLGIM III–IV) have endoscopic surveillance in 2 years, intermediate-risk patients (OLGIM II) in 5 years.

Funder

SCS

Biomedical Research Council

Singapore Ministry of Health’s National Medical Research Council

Publisher

BMJ

Subject

Gastroenterology

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