Comorbidities related to metachronous recurrence for early gastric cancer in elderly patients  

作　　者：Ying Xiang Ying Yuan Zhen-Yu Wang Yan-Mei Zhu Wen-Ying Li Qian-Ge Ye Ya-Nan Wang Qi Sun Xi-Wei Ding Faraz Longi De-Hua Tang Gui-Fang Xu 

机构地区：[1]Department of Gastroenterology,Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine,Nanjing 210008,Jiangsu Province,China [2]Department of Gastroenterology,Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu Province,China [3]Department of Gastroenterology,Nanjing Drum Tower Hospital Clinical College of Jiangsu University,Nanjing 210008,Jiangsu Province,China [4]Department of Gastroenterology,Hospital Clinical College of Nanjing Medical University,Nanjing 210008,Jiangsu Province,China [5]Department of Pathology,Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu Province,China [6]Feinberg School of Medicine,Northwestern University,Chicago,IL 60601,United States

出　　处：《World Journal of Gastrointestinal Endoscopy》2025年第3期21-31,共11页世界胃肠内镜杂志(英文)

基　　金：Supported by the National Natural Science Foundation of China,No.81572338 and No.82170548;C-class-sponsored research project of the Jiangsu Provincial Six Talent Peaks,No.WSN-078;Jiangsu Province“333 High-level Talents Training Project”,No.2016-III-0126;the Jiangsu Provincial Key Research and Development Program,No.BE2021601;the Postgraduate Research and Practice Innovation Program of Jiangsu Province,No.SJCX24_1037.

摘　　要：BACKGROUND A significant association between increased age and an increased risk of metachronous gastric cancer(MGC)following curative endoscopic submucosal dissection(ESD)has previously been reported.AIM To determine risk factors for the metachronous occurrence of early gastric cancer(EGC)in elderly individuals.METHODS This retrospective cohort study comprised 653 elderly patients(aged≥65 years)who underwent curative ESD for EGC between January 2014 and June 2020 at Nanjing Drum Tower Hospital.Comprehensive analyses were conducted to compare lifestyle habits,comorbidities,and Helicobacter pylori(H.pylori)infections as potential indicators.RESULTS During a median follow-up of 38 months,46 patients(7.0%,20.46/1000 person-years)developed MGC in the elderly cohort.The cumulative incidences of MGC at 2,3,and 5 years were 3.3%,5.3%,and 11.5%,respectively.In multivariate Cox regression analyses,the independent risk factors for MGC included metabolic dysfunctionassociated steatotic liver disease(MASLD)[hazard ratio(HR)=2.44,95%confidence interval(CI):1.15-5.17],persistent H.pylori infection(HR=10.38,95%CI:3.36-32.07),severe mucosal atrophy(HR=2.71,95%CI:1.45-5.08),and pathological differentiation of EGC(well/moderately differentiated vs poorly differentiated:HR=10.18,95%CI:1.30-79.65).Based on these risk factors,a risk stratification system was developed to categorize individuals into low(0-1 point),intermediate(2-3 points),and high(4-8 points)risk categories for MGC,with cumulative incidence rates of 12.3%,21.6%,and 45%,respectively.CONCLUSION Among elderly individuals,MASLD,persistent H.pylori infection,severe mucosal atrophy,and well/moderately differentiated EGC were associated with an increased risk of MGC.Elderly patients are recommended to adopt healthy lifestyle practices,and undergo regular endoscopic screening and H.pylori testing after curative ESD for EGC.

关 键 词：COMORBIDITIES Early gastric cancer Metachronous gastric cancer The elderly Risk factors 

分 类 号：R73[医药卫生—肿瘤]