Original article
Clinical endoscopy
Incidence of gastric cancer after endoscopic resection of gastric adenoma

https://doi.org/10.1016/j.gie.2015.10.024Get rights and content

Background and Aims

The annual incidence of metachronous cancer after endoscopic resection (ER) of early gastric cancer (EGC) is approximately 3%. However, the incidence of gastric cancer after ER of a gastric adenoma is not known. The aim of this study was to determine whether the incidence of gastric cancer after ER of a gastric adenoma was different compared with that of metachronous cancer after ER of EGC.

Methods

We retrospectively analyzed data from patients who underwent ER for gastric neoplasia from January 2005 to August 2013. Enrolled patients were divided into 2 groups: patients with low-grade dysplasia were included in the adenoma group and patients with high-grade dysplasia or invasive neoplasia were included in the EGC group. The main outcome was the incidence of gastric cancer after ER.

Results

At a median follow-up of 28 months, gastric cancer newly developed in 13 adenoma patients (3.6%) and in 30 EGC patients (5.1%). The incidence rate of gastric cancer after ER was 14.4 cases per 1000 person-years in adenoma patients and 18.4 cases per 1000 person-years in EGC patients (P = .309 by the log-rank test). The hazard ratio of metachronous neoplasia in adenoma patients compared with EGC patients was 0.97 (95% confidence interval, 0.62–1.53). Metachronous tumors with invasion beyond the muscularis mucosa were more frequent in adenoma patients than in EGC patients (7/35 [20.0%] vs 3/63 [4.8%], P = .017).

Conclusion

The incidence of gastric cancer after ER for gastric adenoma was not significantly different from that of EGC. If further prospective studies confirm these findings, careful endoscopic surveillance with the same level of intensity should be considered for both gastric adenoma and EGC patients after ER.

Section snippets

Patients

We retrospectively analyzed patients who underwent ER for gastric neoplasia between January 2005 and August 2013 at Seoul St. Mary’s Hospital, Seoul, Korea. The histologic criteria of gastric neoplasia were defined as categories 3, 4, and 5 of the Vienna classification.12 We divided the patients into 2 groups: patients with low-grade dysplasia (Category 3 in the Vienna classification) were included in the adenoma group and those with high-grade dysplasia (Category 4) and invasive neoplasia

Results

A total of 1647 patients underwent ER for gastric neoplasia during the study period. Of these, 10 patients underwent ER on the remnant stomach, and 89 underwent additional gastrectomy. Eleven patients had recurrence at the resected site of the primary neoplasia within 12 months, and a synchronous neoplasia in areas other than the site of the primary tumor developed within 12 months in 41 patients. All of these patients were excluded. We also excluded 549 patients with less than 1 year of

Discussion

The purpose of this study was to evaluate whether the incidence of gastric cancer after ER for gastric adenoma was different compared with the incidece of metachronous cancer after ER of EGC. In this study, the incidence of gastric cancer and neoplasia after ER in adenoma patients was 14.4 and 33.3 cases per 1000 person-years, respectively, and these rates did not differ significantly from those in EGC patients. The histological degree of gastric tumor did not affect the incidence of

References (21)

  • A.C. de Vries et al.

    Gastric cancer risk in patients with premalignant gastric lesions: a nationwide cohort study in the Netherlands

    Gastroenterology

    (2008)
  • Y. Maehata et al.

    Long-term effect of Helicobacter pylori eradication on the development of metachronous gastric cancer after endoscopic resection of early gastric cancer

    Gastrointest Endosc

    (2012)
  • J. Nasu et al.

    Characteristics of metachronous multiple early gastric cancers after endoscopic mucosal resection

    Endoscopy

    (2005)
  • H. Jung da et al.

    Endoscopic submucosal dissection for colorectal lateral spreading tumors larger than 10 cm: Is it feasible?

    Gastrointest Endosc

    (2015)
  • M. Kato et al.

    Scheduled endoscopic surveillance controls secondary cancer after curative endoscopic resection for early gastric cancer: a multicentre retrospective cohort study by Osaka University ESD study group

    Gut

    (2013)
  • S.B. Yoon et al.

    Effect of Helicobacter pylori eradication on metachronous gastric cancer after endoscopic resection of gastric tumors: a meta-analysis

    Helicobacter

    (2014)
  • M. Kato et al.

    Endoscopic submucosal dissection as a treatment for gastric noninvasive neoplasia: a multicenter study by Osaka University ESD Study Group

    J Gastroenterol

    (2011)
  • S.Y. Lee

    Gastric adenoma with low-grade dysplasia: two countries, two outcomes

    Dig Dis Sci

    (2014)
  • M. Rugge et al.

    The long term outcome of gastric non-invasive neoplasia

    Gut

    (2003)
  • Y.J. Kim et al.

    Histologic diagnosis based on forceps biopsy is not adequate for determining endoscopic treatment of gastric adenomatous lesions

    Endoscopy

    (2010)
There are more references available in the full text version of this article.

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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. This research was supported by a Basic Science Research Program through the NRF funded by the Ministry of Education, Science, and Technology (NRF-2013R1A1A2007985), by the Catholic Medical Center Research Foundation in the program year of 2014, and by the Global Research and Development Center program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT, and Future Planning (NRF-2011-0031644).

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