Incidence and predictors of gastric neoplastic lesions in corpus atrophic gastritis

Aims In Corpus atrophic gastritis(CAG) the occurrence of gastric-neoplastic-lesions(GNL),as type I neuroendocrine tumors(T1gNET),intraepithelial-neoplasia(IEN),and gastric-cancer(GC) is still debated.We aimed to assess occurrence and predictors of GNL at long-term follow-up(FU).

Methods A prospective-cohort of CAG-patients(diagnosed 2001-2021) adhering to endoscopic-histological-surveillance,according to MAPS-guidelines was considered. In case of new symptoms, onset of anemia, gastroscopy was anticipated.

Results A total of 275 CAG-patients[72.0% female, median-age 61(23-84) years] were included, median FU 5(1-17)years. Overall, 58 GNL were detected(Table.1). All GNL were OLGA-score-2, except 2 LG-IEN and 1 T1gNET with OLGA-1. CAG-patients with age>60-years, IM without pseudopyloric-metaplasia(PPM), and pernicious-anemia(PA) were at 4.7(95%CI 1.0-21-1), 4.3(95%CI 1.4-12.9), and 4.3-fold(95%CI 1.3-13.8) higher-risk for development of GC/HG-IEN or LG-IEN. PA was independent-risk factor for development of T1gNET[HR 2.2(95%CI 1.0-4.8)]. The presence of PA,IM without PPM, and age>60-years were associated to a shorter mean-overall-survival-time free of GC/HG-IEN or LG-IEN(p=0.008,p=0.04,p=0.002,respectively). A shorter mean-overall-time-free of T1gNET was observed in case of severe-corpus-atrophy and PA(p=0.04,p=0.03,respectively) ([Table 1]).

Table 1  Crude incidence and annual incidence rate person-year of the 58 gastric neoplastic lesions at long-term FU in 275 CAG patients.

Conclusions Our study confirms the higher risk of developing GNL in CAG-patients, despite the low-risk OLGA scores. Regular surveillance should be proposed in CAG-patients, in particular in patients with age>60-years of age, IM without PPM, PA, or with severe-corpus-atrophy at diagnosis, possibly optimizing surveillance-strategies.

Publication History

Article published online:
14 April 2023