Incidence of gastric cancer among patients with gastric precancerous lesions: observational cohort study in a low risk Western population [胃癌前病变患者的胃癌发病率：对低风险西方人群的观察性队列研究]

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BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h3867 (Published 27 July 2015)

Cite this as: BMJ 2015;351:h3867

Authors
Huan Song, PhD candidate, Isabella Guncha Ekheden, PhD candidate, Zongli Zheng, postdoctoral scientist, Jan Ericsson, professor, Olof Nyrén, professor, Weimin Ye, professor 

Abstract
Objective: To accurately measure the incidence of gastric cancer among patients with gastric precancerous lesions, and to quantify the excess incidence in comparison with people with normal mucosa on endoscopy and a general population.

Design: Population based cohort study.

Setting: Population of Sweden using data from its national disease registers.

Participants: 405 172 patients who had gastric biopsy samples taken for non-malignant indications between 1979 and 2011.

Main outcome measures: Incidence of gastric cancer, reported separately for patients with different mucosal changes in biopsy samples. Standardised incidence ratios provided estimation of the relative risk, using the general Swedish population as reference; and hazard ratios were derived from Cox regression modelling for internal comparisons with patients with normal gastric mucosa.

Results: After excluding the first two years of follow-up, 1599 cases of gastric cancer were identified. The annual crude incidence of gastric cancer was 20×10−5 for those in the normal mucosa group (standardised incidence ratio 1.0), 42×10−5 for those with minor changes (1.5), 59×10−5 for the gastritis group (1.8), 100×10−5 for the atrophic gastritis group (2.8), 129×10−5 for the intestinal metaplasia group (3.4), and 263×10−5 for the dysplasia group (6.5). Cox regression modelling confirmed that excess risks increased monotonically with progressive severity of gastric lesions, with the highest hazard ratio of 10.9 (dysplasia versus normal mucosa, 95% confidence interval 7.7 to 15.4). The increased incidence was stable throughout the follow-up period, and the gaps between cumulative incidence curves grew continuously.

Conclusions: Among patients who undergo gastroscopy with biopsy for clinical indications, approximately 1 in 256 with normal mucosa, 1 in 85 with gastritis, 1 in 50 with atrophic gastritis, 1 in 39 with intestinal metaplasia, and 1 in 19 with dysplasia will develop gastric cancer within 20 years. These numbers, along with cost-benefit analyses, should guide future surveillance policies for these particular patient groups.