Can patients with mild non-neoplastic lesions diagnosed at baseline screening be safely exempt from surveillance: evidence from multicenter community-based cohorts  

作　　者：Siyi He Zhiyi Zhang Guohui Song Zhenhai Wang Chunyun Dai Shipeng Yan Kun Jiang Bingbing Song He Li Maomao Cao Dianqin Sun Fan Yang Xinxin Yan Shaoli Zhang Yi Teng Qianru Li Changfa Xia Wanqing Chen 

机构地区：[1]Office of Cancer Screening,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China [2]Department of Gastroenterology,Gansu Wuwei Tumor Hospital,Wuwei 730000,China [3]Cixian Cancer Institute,Handan 056500,China [4]Linzhou Cancer Hospital,Linzhou 456550,China [5]Center for Disease Control and Prevention of Sheyang County,Yancheng 224499,China [6]Department of Cancer Prevention and Control,Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University,Changsha 410029,China [7]Luoshan Center for Disease Control and Prevention,Xinyang 464299,China [8]Office for Cancer Control and Research,Affiliated Cancer Hospital of Harbin Medical University,Harbin 150081,China

出　　处：《Science China(Life Sciences)》2025年第1期263-271,共9页中国科学(生命科学英文版)

基　　金：supported by the National Natural Science Foundation of China(82273721);Special Project of Beijing-Tianjin-Hebei Basic Research Cooperation(J200017);Sanming Project of Medicine in Shenzhen(SZSM201911015).

摘　　要：Surveillance recommendations for gastric cancer(GC)in current guidelines focused on advanced precancerous lesions and were based on precise diagnosis of severity/extent of baseline lesions.We aimed to develop a less endoscopy-related equipment-dependent risk-stratification tool,and assessed whether mild-precursor-lesion patients can be safely exempt from surveillance.In the multicenter communitybased cohort,75,051 participants receiving baseline endoscopy were enrolled during 2015–2017 and followed-up until 2021.Cumulative incidence rates(CIRs)of GC for precancerous-conditions were calculated by Kaplan-Meier method and compared by Log-rank tests.Mixedeffects Cox regression models were used to detect potential factors for progression towards GC.A risk score was calculated as counts of selected factors.An independent cohort,including 26,586 participants was used for external validation.During a median follow-up of 6.25 years,CIRs of GC were 0.302%,0.436%,and 4.756%for normal group,non-neoplastic(atrophic gastritis/intestinal metaplasia)and neoplastic lesions(low-grade/high-grade dysplasia),respectively(Ptrend<0.001).Four predictors,including male,≥60 years,smoking,and limited vegetable consumption,were selected for risk-stratification.High-risk patients(≥3 risk factors)with non-neoplastic lesions showed higher GC risks(adjusted HR=7.73,95%CI:4.29–13.92),and their four-year CIR reached the one-year CIR of neoplastic lesions.Further categorizing non-neoplastic lesions by histological grade,both patients with moderate-to-severe lesions(aHR=3.07,95%CI:1.67–5.64)and high-risk patients with mild lesions(aHR=7.29,95%CI:3.58–14.86)showed higher risks.Consistent trends were observed in validation cohort.High-risk mild-precursor-lesion patients should receive surveillance within 3–5 years after baseline screening.Our study provides evidence on supplementing current guideline recommendations.

关 键 词：stomach neoplasms precancerous conditions cancer screening cumulative incidence risk stratification 

分 类 号：R73-31[医药卫生—肿瘤]