A 5.5-year surveillance of esophageal and gastric cardia precursors after a population-based screening in China.

Journal of gastroenterology and hepatology

PubMedID: 26183370

Wen D, Zhang L, Wang X, Li Y, Ma C. A 5.5-year surveillance of esophageal and gastric cardia precursors after a population-based screening in China. J Gastroenterol Hepatol. 2015;.
BACKGROUND AND AIM
This study aimed to estimate the time to precursor progression and to identify significant predicators.

METHODS
One hundred thirty-three precursor and 311 normal cases detected in a population-based screening were surveyed for 5.5 years. Precursor progression was defined as worsening of dysplasia or development of a new precursor. Time to precursor progression was estimated by the Kaplan-Meier method. Significant predicators were estimated by Cox proportional regression.

RESULTS
Of the 133 precursor cases, 33.08% (44/133) progressed or recurred, 30.08% (40/133) persisted, and 36.84% (49/133) regressed; of the 311 normal subjects, 13.50% (42/311) developed a precursor. Progression occurred significantly earlier and more frequently with ncreasing histology: with mind dysplasia (mD), 7.8% progressed by 1?year and 23.3% progressed by 5?year; with moderate dysplasia (MD), 18% progressed by 1?year and 70% progressed by 5?years; and with severe dysplasia, 50% progressed by 1?year and 100% progressed by 5?years. The difference between any two groups was significant. In addition, the marginal Lugol-stained mucosa at endoscopic mucosal resection had a progressing risk similar to that of MD, and basal cell hyperplasia was similar to that of mD. Significant predicators for precursor progression included male sex (hazard ratio and 95% CI: 2.74 (1.63-4.60)), age over 50?years (2.31 (1.33-4.02)), family history of upper gastrointestinal cancer (UGIC) (1.56 (1.00-2.45)), multifocal dysplasia (5.11 (3.01-8.68)), and baseline histology.

CONCLUSIONS
Sex, age, family history of UGIC, multifocal dysplasia, and baseline histology are significant independent predicators for precursor progression. Patients after endoscopic mucosal resection should be continuously surveyed.