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J Gastroenterol Hepatol. 2016 May;31(5):953-8. doi: 10.1111/jgh.13249.

Incomplete type of intestinal metaplasia has the highest risk to progress to gastric cancer: results of the Spanish follow-up multicenter study.

Author information

1
Unit of Nutrition, Environment and Cancer, Institut Català d'Oncología, Barcelona, Spain.
2
University of Alcalá (Department of Medicine and Medical Especialties), Department of Pathology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain.
3
Cancer Epigenetics and Biology Program, IDIBELL, Barcelona.
4
Department of Pathology, Hospital Universitario de la Princesa, IIS-IP, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid.
5
Department of Gastroenterology, Hospital Universitario de la Princesa, IIS-IP, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid.
6
Department of Gastroenterology, Hospital Universitario La Paz, Madrid.
7
Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain.
8
Department of Gastroenterology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares.
9
Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain.
10
Department of Pathology, Hospital Universitario Río Hortega, Valladolid, Spain.
11
Department of Pathology, Hospital Clínic de Barcelona, IDIBAPS and CIBEREHD, and Universitat de Barcelona, Spain.
12
Department of Gastroenterology, Hospital Clínic de Barcelona, IDIBAPS and CIBEREHD, Spain.
13
Department of Pathology, and Department of Gastroenterology. Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU). CIBEREHD, San Sebastián, Spain.
14
Department of Pathology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, and CIBEREHD, Spain.
15
Department of Gastroenterology, Hospital de Viladecans, Spain.
16
Department of Pathology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.
17
Departament of Medicine, Digestive Diseases Service, Institut Universitari Parc Taulí, Sabadell, and CIBEREHD, Spain.

Abstract

BACKGROUND AND AIM:

In high or moderate risk populations, periodic surveillance of patients at risk of progression from gastric precursor lesions (PL) to gastric cancer (GC) is the most effective strategy for reducing the burden of GC. Incomplete type of intestinal metaplasia (IIM) may be considered as the best candidate, but it is still controversial and more research is needed. To further assess the progression of subtypes of IM as predictors of GC occurrence.

METHODS:

A follow-up study was carried-out including 649 patients, diagnosed with PL between 1995-2004 in 9 participating hospitals from Spain, and who repeated the biopsy during 2011-2013. Medical information and habits were collected through a questionnaire. Based on morphology, IM was sub-classified as complete (small intestinal type, CIM) and incomplete (colonic type, IIM). Analyses were done using Cox (HR) models.

RESULTS:

At baseline, 24% of patients had atrophic gastritis, 38% CIM, 34% IIM, and 4% dysplasia. Mean follow-up was 12 years. 24 patients (3.7%) developed a gastric adenocarcinoma during follow-up. The incidence rate of GC was 2.76 and 5.76 per 1,000 person-years for those with CIM and IIM, respectively. The HR of progression to CG was 2.75 (95% CI 1.06-6.26) for those with IIM compared with those with CIM at baseline, after adjusting for sex, age, smoking, family history of GC and use of NSAIDs.

CONCLUSIONS:

IIM is the PL with highest risk to progress to GC. Sub-typing of IM is a valid procedure for the identification of high risk patients that require more intensive surveillance.

KEYWORDS:

follow-up study; gastric cancer risk; intestinal metaplasia

PMID:
26630310
DOI:
10.1111/jgh.13249
[Indexed for MEDLINE]

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